{"hospital_name":"Providence Health And Services - Washington","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence Sacred Heart Medical Center and Children's Hospital"],"hospital_address":["101 W 8th Ave, Spokane, WA 99204"],"license_information":{"license_number":"HAC.FS.00000162","state":"WA"},"type_2_npi":["1891947263","1144471715","1639320484"],"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":"Justin Voelker"},"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":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"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 Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera Medicaid Managed Care Plan","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":"Asuris All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Asuris Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","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":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Exchange","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":"PacificSource","plan_name":"Navigator All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"ACO Tiered 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":"Behavioral Health Plan","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 - Behavioral Health","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."},{"payer_name":"UnitedHealthCare","plan_name":"Navigate Exchange","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"HC CATH INTRO SET ADULT 8FR TRANS 008591","code_information":[{"code":"Px0000100832L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE CHOICE PT .014-300CM H74912154012","code_information":[{"code":"Px0000100988L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH MAHURKAR CRV 16CM 8830415003","code_information":[{"code":"Px0000101349L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.9,"discounted_cash":297.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH KIT MICROSNARE 4MM SK400","code_information":[{"code":"Px0000102235L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HICKMAN DUAL LUMEN 13.5FR 0600662","code_information":[{"code":"Px0000104016L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":595.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RADIAL ARTERY RA04020","code_information":[{"code":"Px0000104062L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.24,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTERCEED 3X4 4350 CDM","code_information":[{"code":"Px0000104075L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.0,"discounted_cash":883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERICARDIOCENTESIS PIGTAIL","code_information":[{"code":"Px0000105783L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOSTATIC SURGICEL 2X3 1953","code_information":[{"code":"Px0000106030L","type":"CDM"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOSTATIC SURGICEL 4X8 1952","code_information":[{"code":"Px0000106035L","type":"CDM"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH SUPRAPUBIC BARD 12FR 143112","code_information":[{"code":"Px0000109527L","type":"CDM"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET DIL REN AMPL 6-30FR 16CM G14292","code_information":[{"code":"Px0000109541L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.0,"discounted_cash":717.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CATH NC RANGER 2.5X15 1537425","code_information":[{"code":"Px0000111178L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2320.0,"discounted_cash":1624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PANCREATIC GRENAN 5FR 5C","code_information":[{"code":"Px0000112429L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CSF FIBEROPTIC ICP CAMINO 1104B","code_information":[{"code":"Px0000113282L","type":"CDM"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1814.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 20FR 3.0 01202030","code_information":[{"code":"Px0000114848L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDWL SLIT1 18GA KT 0295006000","code_information":[{"code":"Px0000115041L","type":"CDM"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FIXED CURVE 115CM 6FR F6QF005RT","code_information":[{"code":"Px0000115435L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.32,"discounted_cash":439.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .018X180CM GR1806","code_information":[{"code":"Px0000115448L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRO SET 9FR 808900","code_information":[{"code":"Px0000115534L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL HAWKINS-AKINS BLNT 18GA 15 G05045","code_information":[{"code":"Px0000115845L","type":"CDM"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .035 145CM G00691","code_information":[{"code":"Px0000115848L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET ACCESS INTRAHEPTIC TRANS-J G06541","code_information":[{"code":"Px0000116130L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1513.0,"discounted_cash":1059.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE DOC .014/.018-145CM 22260","code_information":[{"code":"Px0000116505L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH KIT SNARE GN 6FR 25MM GN2500","code_information":[{"code":"Px0000117030L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE ANG TAPER 5FR 65CM CG507","code_information":[{"code":"Px0000117231L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VORTX 18-3-3.3 M0013822031","code_information":[{"code":"Px0000117618L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VORTX 18-4-4.7 M0013822041","code_information":[{"code":"Px0000117619L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VORTX 18-6-6.7 M0013822061","code_information":[{"code":"Px0000117621L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE CHOICE EX SUP 182CM","code_information":[{"code":"Px0000118218L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE CHOICE PT .014-182CM H74912160012","code_information":[{"code":"Px0000118220L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN XXL 14 X 4 X 75 M001145140","code_information":[{"code":"Px0000118901L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN WEDGE 7FR AI07127","code_information":[{"code":"Px0000119264L","type":"CDM"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 7F 25CM RSS706","code_information":[{"code":"Px0000119320L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 20FR 4.0 01202040","code_information":[{"code":"Px0000120547L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE HTF .014-190CM 22339M","code_information":[{"code":"Px0000120803L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE PLAT PLUS .014-300CM H74917521","code_information":[{"code":"Px0000122212L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRN MP 6SP 10.2F 45CM G09766","code_information":[{"code":"Px0000122632L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DAWSON-MUELLER 8.5FR 25CM G09705","code_information":[{"code":"Px0000122635L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ULT 8.5 38 45P6S CLM RH G09765","code_information":[{"code":"Px0000122636L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ULT 12.0 38 45 P6S CLM RH G09767","code_information":[{"code":"Px0000122647L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG EXCH .035 260CM GR3509","code_information":[{"code":"Px0000123611L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.46,"discounted_cash":332.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEPRAFILM ADHESION BARRIER 5X6 430102","code_information":[{"code":"Px0000124099L","type":"CDM"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.0,"discounted_cash":1027.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE JB1 5FR 100CM CG514","code_information":[{"code":"Px0000124411L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":309.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH KIT SNARE GN 4FR 5MM GN500","code_information":[{"code":"Px0000124904L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":713.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT SNARE GOOSENECK 15MM HOOP GN1500","code_information":[{"code":"Px0000124905L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FCP URETEROSCPY BX PIRANHA 3FR M0065051600","code_information":[{"code":"Px0000125383L","type":"CDM"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":971.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDECATH 4FR 65CM ANGLE TAPER CG415","code_information":[{"code":"Px0000127226L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.32,"discounted_cash":208.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL COAXIAL ACHIEVE BIOPSY 18G X 11CM CA1811","code_information":[{"code":"Px0000127687L","type":"CDM"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE SS ANG EX .035 260 GS3509","code_information":[{"code":"Px0000127738L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.2,"discounted_cash":194.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SM CVD 7FR/4MM M0045031TK10","code_information":[{"code":"Px0000127871L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2157.0,"discounted_cash":1509.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SAFL 8.5FR 406868","code_information":[{"code":"Px0000127887L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DECA CSL 6F 65 401353","code_information":[{"code":"Px0000127892L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1467.0,"discounted_cash":1026.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRO 8FR 808800","code_information":[{"code":"Px0000127906L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE GLD STIFF ST EXC .035 260 GS3504","code_information":[{"code":"Px0000128038L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PIG WSC 5FR 70CM G05189","code_information":[{"code":"Px0000128043L","type":"CDM"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEPH FLEX REG 8 X 25 M001271790","code_information":[{"code":"Px0000128059L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE SUPER STIFF 75CM","code_information":[{"code":"Px0000128211L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MAC-LOC 10.2FR 25 CLDM HC G09706","code_information":[{"code":"Px0000128498L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRAINAGE 14.0P-6S CLM RH G09504","code_information":[{"code":"Px0000128500L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOP COAXIAL ACHIEVE 18X15","code_information":[{"code":"Px0000128518L","type":"CDM"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT GLIDEX 8FR X 24CM M001245510","code_information":[{"code":"Px0000128769L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.2,"discounted_cash":332.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .035 180CM GR3508","code_information":[{"code":"Px0000128901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO FASTCATH 12FR 12CM 406301","code_information":[{"code":"Px0000129114L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACURE HOOKWIRE 20GX7.5CM BLN20075","code_information":[{"code":"Px0000129928L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 24FR 2.5 01202425","code_information":[{"code":"Px0000132298L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 7F 11CM 401711M","code_information":[{"code":"Px0000132416L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":329.86,"discounted_cash":230.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE AMPLATZ SS J 035 180CM M001465011","code_information":[{"code":"Px0000132749L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.86,"discounted_cash":230.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE VASC ANG .035INX180CM GS3508","code_information":[{"code":"Px0000132914L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.65,"discounted_cash":346.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 6FR 11CM 401611M","code_information":[{"code":"Px0000133231L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFLATION DEVICE ENCORE 26 H74904527011","code_information":[{"code":"Px0000133371L","type":"CDM"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE LOC .035 115CM","code_information":[{"code":"Px0000134475L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.12,"discounted_cash":199.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEPH FLEX REG 12 X 25 M001271810","code_information":[{"code":"Px0000134619L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE CHOICE FLOPPY 182CM 5/BX H74912132012","code_information":[{"code":"Px0000134753L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIL BILI 6.0 FR G21571","code_information":[{"code":"Px0000134880L","type":"CDM"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GRASPER FCP STN 3-PRNG 3FR 120 M0063701230","code_information":[{"code":"Px0000134977L","type":"CDM"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE COPE 018 60CM NITINL G08427","code_information":[{"code":"Px0000135895L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":209.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAABE 7F 55CM G11633","code_information":[{"code":"Px0000137229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 8FR 11CM 401811M","code_information":[{"code":"Px0000138229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FLEXIMA LOCKING-PIG 12FR M001271380","code_information":[{"code":"Px0000138506L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":982.0,"discounted_cash":687.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE BALANCE HEAVY WT 300CM 1000463H","code_information":[{"code":"Px0000139359L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE BALANCE TREK .014-190CM 1005159H","code_information":[{"code":"Px0000139561L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FOGARTY 5.5FR 12TLW805F35","code_information":[{"code":"Px0000139737L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.44,"discounted_cash":418.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SR2 CRV 8.5FR 60CM 406855","code_information":[{"code":"Px0000139776L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 6F 25CM RSS606","code_information":[{"code":"Px0000140706L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE SPARTACORE 14 190CM 1005205","code_information":[{"code":"Px0000141230L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PICC INTRO NEO 1.9","code_information":[{"code":"Px0000141267L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.99,"discounted_cash":296.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANCHR SUT COPE GI G04474","code_information":[{"code":"Px0000141533L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT GLIDEX 8FR X 26CM M001245520","code_information":[{"code":"Px0000141651L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 2S C2 G06236","code_information":[{"code":"Px0000141849L","type":"CDM"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET ACCESS ROSCH-UCHIDA LIVER G06929","code_information":[{"code":"Px0000142056L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1330.0,"discounted_cash":931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BIL 10.2FR 40CM CLB RH G09498","code_information":[{"code":"Px0000142230L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":268.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BIL MACLC 8.5FR 40 CLB RH G09497","code_information":[{"code":"Px0000142231L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BIL 12FR 40CM CLB RH G09499","code_information":[{"code":"Px0000142232L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RENEGADE18 2TP 150/10CM M001182570","code_information":[{"code":"Px0000143610L","type":"CDM"}],"standard_charges":[{"gross_charge":2264.0,"discounted_cash":1584.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE SOFTIPXF 6FR 40 90C H965100420","code_information":[{"code":"Px0000143614L","type":"CDM"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":784.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE VASC TRANSEND EX-P .014 M001468080","code_information":[{"code":"Px0000143619L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":1031.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 22FR 025022","code_information":[{"code":"Px0000143925L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":719.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BIL MACLOC 14FR 40 CLB RH G09500","code_information":[{"code":"Px0000143926L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 6F 10CM RSS602","code_information":[{"code":"Px0000144473L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.86,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 7FR 10CM RSS702","code_information":[{"code":"Px0000144474L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.86,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINN 8FR 10CM RSS802","code_information":[{"code":"Px0000144475L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.86,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINN 5FR 25CM RSS506","code_information":[{"code":"Px0000144755L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 16FR 038 35CM G27023","code_information":[{"code":"Px0000144955L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE .038 9FR 10CM RSS902","code_information":[{"code":"Px0000144976L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":90.86,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAIN SET TQAS POLYU 41CM 20FR G06345","code_information":[{"code":"Px0000145079L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAIN 16FR .038 40CM","code_information":[{"code":"Px0000145116L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAIN 18FR .038 40CM G12510","code_information":[{"code":"Px0000145117L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GORDON 20FR 40 MPA GLD HC G12511","code_information":[{"code":"Px0000145118L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GORDON 22FR 40 MPA GLD HC","code_information":[{"code":"Px0000145119L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH PLEURAL PLEURX","code_information":[{"code":"Px0000145225L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2293.0,"discounted_cash":1605.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER ACCUSTICK INTRO SET M001207100","code_information":[{"code":"Px0000145243L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEPH FLEX REG 10 X 25 M001271800","code_information":[{"code":"Px0000145418L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":298.32,"discounted_cash":208.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN 16MM/4CM 75CM XXL M001145520","code_information":[{"code":"Px0000146268L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT GLIDEX 8FR X 22CM M001245500","code_information":[{"code":"Px0000147877L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMOBILIZER KNEE UNIV 19IN","code_information":[{"code":"Px0000149139L","type":"CDM"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE TRANSEND .014 EX SOFT TIP M001468060","code_information":[{"code":"Px0000149421L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1767.85,"discounted_cash":1237.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 7CM G09489","code_information":[{"code":"Px0000149891L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ARTERY RADIAL G01908","code_information":[{"code":"Px0000150354L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE AMPLATZ SS .035 145CM M001465231","code_information":[{"code":"Px0000150936L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THORACENTESIS PLEURA-SEAL AK01000","code_information":[{"code":"Px0000153464L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDE INTRO 7FR RDC1 4037553R","code_information":[{"code":"Px0000153873L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH UNIFUSE 5F/135CM/40CM H787124018155","code_information":[{"code":"Px0000154020L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URET 20CM 8FR M001245490","code_information":[{"code":"Px0000154489L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE TRANSEND EX .014 182 M001468050","code_information":[{"code":"Px0000154695L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":1031.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRODUCER AVANTI 4FR 504604X","code_information":[{"code":"Px0000154767L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.68,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL ECHOTIP CHIBA 21G 65.5CM G06987","code_information":[{"code":"Px0000154925L","type":"CDM"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDECATH SIM2 4/100 CG402","code_information":[{"code":"Px0000155342L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.32,"discounted_cash":208.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE WHISPER .014-300 1005359H","code_information":[{"code":"Px0000155415L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYR EMBO 100-300MIC 2ML VIAL","code_information":[{"code":"Px0000155703L","type":"CDM"}],"standard_charges":[{"gross_charge":1101.03,"discounted_cash":770.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOP BONE 11GAX10CM G12373","code_information":[{"code":"Px0000155729L","type":"CDM"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT PARACENTESIS","code_information":[{"code":"Px0000156015L","type":"CDM"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EMBOL TRUFILL BCA 1GM TANT 631400","code_information":[{"code":"Px0000156040L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":21651.0,"discounted_cash":15155.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET EMBL GLUE TRUFILL N-BCA 631500","code_information":[{"code":"Px0000156041L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":10758.0,"discounted_cash":7530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE MAILMAN 182CM H74912136012","code_information":[{"code":"Px0000156151L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE SV5 .018 503558","code_information":[{"code":"Px0000156164L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT WALLGRAFT 6F 8X60 75CM","code_information":[{"code":"Px0000156300L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE MAILMAN 300 .014 H74912120012","code_information":[{"code":"Px0000156356L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BIL DRAIN 18FR 40CM G09829","code_information":[{"code":"Px0000156887L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFUSION 4FR 90CM 10CM H787124018185","code_information":[{"code":"Px0000156959L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.29,"discounted_cash":1053.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFUSION 4FR 90CM 20CM H787124018195","code_information":[{"code":"Px0000156960L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":555.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RCFW 18F 30CM CHECK-FLO G11672","code_information":[{"code":"Px0000157263L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 14CM 10MM G26991","code_information":[{"code":"Px0000159156L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 14CM 12MM G26992","code_information":[{"code":"Px0000159157L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SIZING PIG 5F 65CM 20MARK 532598C","code_information":[{"code":"Px0000159158L","type":"CDM"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC EXCLSOR SL10 STR 2TIP M0031681890","code_information":[{"code":"Px0000159428L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.06,"discounted_cash":2205.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AMPLATZ SS 180CM .038 ST M001465191","code_information":[{"code":"Px0000159522L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AMPLATZ SS 260CM .035 3MMJ M001465021","code_information":[{"code":"Px0000159523L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.23,"discounted_cash":241.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE TRANSEND .010 205 M003468020","code_information":[{"code":"Px0000160205L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":1031.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEPH FLEX REG 14 X 25 M001271820","code_information":[{"code":"Px0000160336L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PEELWY 20FR .038 13CM G06445","code_information":[{"code":"Px0000160468L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ENPROS WSTNT 9FR 16X60MM H965403320","code_information":[{"code":"Px0000160482L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3113.0,"discounted_cash":2179.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRAIN NITINOL PIG 10FR","code_information":[{"code":"Px0000160899L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":353.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRAIN NITINOL PIG 12FR NNU12LPT","code_information":[{"code":"Px0000160900L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":353.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ 6X40MMX75CM CQ7564","code_information":[{"code":"Px0000161059L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ 10X40MMX75CM CQ75104","code_information":[{"code":"Px0000161060L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ 12X40MMX75CM CQ75124","code_information":[{"code":"Px0000161062L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT REPAIR BROVIAC CATH PEDS 601600","code_information":[{"code":"Px0000200487L","type":"CDM"}],"standard_charges":[{"gross_charge":1556.25,"discounted_cash":1089.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJUNAL MIC 14FR 20CC BL 020014","code_information":[{"code":"Px0000200836L","type":"CDM"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJUNAL FEED 16FR 20CC BL 020016","code_information":[{"code":"Px0000200837L","type":"CDM"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SNARE 7MM LOOP NO. SK700","code_information":[{"code":"Px0000201632L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"discounted_cash":1285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE WHOLEY HI-TORQUE","code_information":[{"code":"Px0000201740L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN WEDGE 6-110 AI07126","code_information":[{"code":"Px0000201775L","type":"CDM"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HICKMAN SLIMPRT INTRO 6FR","code_information":[{"code":"Px0000202020L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SRO 406844","code_information":[{"code":"Px0000203284L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.96,"discounted_cash":534.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SR2 406846","code_information":[{"code":"Px0000203285L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SL1 406840","code_information":[{"code":"Px0000203287L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.96,"discounted_cash":534.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SL2 406841","code_information":[{"code":"Px0000203288L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.96,"discounted_cash":534.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL TRANSSEPTAL BRK 18G 71CM 407200","code_information":[{"code":"Px0000203292L","type":"CDM"}],"standard_charges":[{"gross_charge":845.7,"discounted_cash":591.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL TRANSSEPTAL BRK-1 71 CM 407201","code_information":[{"code":"Px0000203293L","type":"CDM"}],"standard_charges":[{"gross_charge":845.7,"discounted_cash":591.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE CHOICE EX SUP 300CM 5/BX H74912119012","code_information":[{"code":"Px0000203400L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BERMAN ANGIO 7FR 110CM AI07137","code_information":[{"code":"Px0000203684L","type":"CDM"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":660.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE BMW 190CM","code_information":[{"code":"Px0000203762L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE IRON MAN 190CM 1001309","code_information":[{"code":"Px0000203763L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BROVIAC SL 6.6FR 0600540","code_information":[{"code":"Px0000203934L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAIN SET TQAS POLYU 41CM 16FR G06339","code_information":[{"code":"Px0000204323L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV ARROW DL 4FR 8CM AK15402","code_information":[{"code":"Px0000204577L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH KSAW-7.0-38-90-RBSHTLHC G12835","code_information":[{"code":"Px0000204940L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":351.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE ANG .025X150 GR2504","code_information":[{"code":"Px0000204962L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SOS 1 4F/80CM/.035 5/BX","code_information":[{"code":"Px0000204972L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SAFE 7FR 13CM HLS1007M","code_information":[{"code":"Px0000205073L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE V-18 .018/8/200 M001468520","code_information":[{"code":"Px0000205134L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE V-18 .018/8/300 M001468540","code_information":[{"code":"Px0000205135L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":292.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE ROSEN 035 180CM 1.5M G01264","code_information":[{"code":"Px0000205188L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAINAGE THAL TQAS-1800-J G06343","code_information":[{"code":"Px0000205542L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ZMED 20MM X 4CM 611757","code_information":[{"code":"Px0000205679L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.0,"discounted_cash":1673.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ENDOTAK RELIANCE 158","code_information":[{"code":"Px0000205755L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":7257.0,"discounted_cash":5079.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LUMBAR ACCESS 46419","code_information":[{"code":"Px0000205823L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 45CM CL07645","code_information":[{"code":"Px0000205895L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 7FR 45CM CL07745","code_information":[{"code":"Px0000205903L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 8FR 45CM CL07845","code_information":[{"code":"Px0000205904L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.6,"discounted_cash":351.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SCREW-IN 507645","code_information":[{"code":"Px0000206241L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SCREW-IN 507652","code_information":[{"code":"Px0000206264L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LASSO 12MM D7-L10-12-RT","code_information":[{"code":"Px0000206310L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3798.88,"discounted_cash":2659.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE SPARTACORE 5/190 1005202","code_information":[{"code":"Px0000206332L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE PT GRAPHIX 182CM H74914902012","code_information":[{"code":"Px0000206363L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 700-900 2ML S820GH","code_information":[{"code":"Px0000206383L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.03,"discounted_cash":770.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 900-1200 2ML S1020GH","code_information":[{"code":"Px0000206384L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATTRO NO. 694765","code_information":[{"code":"Px0000206737L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOP BONE 11GAX15CM G12374","code_information":[{"code":"Px0000206951L","type":"CDM"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOP BONE 13GAX15CM G12500","code_information":[{"code":"Px0000206952L","type":"CDM"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV ARROW DL 4FR 13CM AK14402","code_information":[{"code":"Px0000207016L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH LR CHECKFLOW INTRO G10626","code_information":[{"code":"Px0000207039L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SCREW-IN 507658","code_information":[{"code":"Px0000207098L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRANSGASTRIC JEJUANL 16F 025016","code_information":[{"code":"Px0000207319L","type":"CDM"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":719.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH G-J TUBE 18FR 30CM","code_information":[{"code":"Px0000207320L","type":"CDM"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":719.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDECATH SIM1 4/100 CG401","code_information":[{"code":"Px0000207432L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.32,"discounted_cash":208.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SHUTTLE 7F/80CM G13338","code_information":[{"code":"Px0000207756L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH FLEXR 10FR .038 80CM RB G13033","code_information":[{"code":"Px0000207916L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE THRUWAY 190CM SHRT TAPER","code_information":[{"code":"Px0000208219L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD PACEMAKER MEDTRONIC 383069","code_information":[{"code":"Px0000208286L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":892.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EXPRESS LD 7X17X75","code_information":[{"code":"Px0000208456L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4422.0,"discounted_cash":3095.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EXPRESS LD 8 X 37 X 75 H74938046840750","code_information":[{"code":"Px0000208459L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EXPRESS LD 9X25X75 H74938046920750","code_information":[{"code":"Px0000208461L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4842.0,"discounted_cash":3389.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EXPRESS LD 9 X 37 X 75 H74938046940750","code_information":[{"code":"Px0000208462L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5039.0,"discounted_cash":3527.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EXPRESS LD 10X37X75 H74938046104070","code_information":[{"code":"Px0000208464L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH UNIFUSE 5F/90CM/30CM H787124018085","code_information":[{"code":"Px0000208467L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":820.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 14FR 1.5 01201415","code_information":[{"code":"Px0000208642L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ENPROS WSTNT 20X40X75","code_information":[{"code":"Px0000208646L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2986.0,"discounted_cash":2090.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STEEL CORE 18LT 018 190CM","code_information":[{"code":"Px0000208924L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 2.7 01201827","code_information":[{"code":"Px0000208978L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 4.0 01201840","code_information":[{"code":"Px0000209001L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI EXPR 8X27MMX75CM H74938046830750","code_information":[{"code":"Px0000209028L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5012.0,"discounted_cash":3508.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 2.5 01201825","code_information":[{"code":"Px0000209080L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 3.5 01201835","code_information":[{"code":"Px0000209128L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD FINELINE II EASY 4471","code_information":[{"code":"Px0000210288L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH DESTINATION ST 6/45 RSR01","code_information":[{"code":"Px0000210630L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IABP 8FR 40CC 068400043101","code_information":[{"code":"Px0000210922L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3339.0,"discounted_cash":2337.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IABP 8FR 34CC 068400043001","code_information":[{"code":"Px0000210923L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3339.0,"discounted_cash":2337.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SRO 8.5F 406853","code_information":[{"code":"Px0000211266L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.96,"discounted_cash":534.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VALVE SPEAKING PASSY-MUIR PMV2001","code_information":[{"code":"Px0000215999L","type":"CDM"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.61,"discounted_cash":272.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BRUSH CYTO CATH RX M00545000","code_information":[{"code":"Px0000216518L","type":"CDM"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL VERT FACET INTRO 13G 5IN","code_information":[{"code":"Px0000216653L","type":"CDM"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE ST .035 260CM G00655","code_information":[{"code":"Px0000216747L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOPINCE 18X15CM 360158001","code_information":[{"code":"Px0000216901L","type":"CDM"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOPINCE 18X20CM 360208001","code_information":[{"code":"Px0000216902L","type":"CDM"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTD BIOPINCE COAXIAL US MCXS1815BP","code_information":[{"code":"Px0000216904L","type":"CDM"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VORTX 35-3-6 M0013733061","code_information":[{"code":"Px0000216910L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH VISC 5FR 80CM .038 MIK G09312","code_information":[{"code":"Px0000217173L","type":"CDM"}],"standard_charges":[{"gross_charge":198.99,"discounted_cash":139.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":540.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER VENA CAVA OPTSE 6F/55CM 466F220A","code_information":[{"code":"Px0000217370L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":3725.0,"discounted_cash":2607.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIAG ACUNAV 10F 8255790","code_information":[{"code":"Px0000217574L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":7490.0,"discounted_cash":5243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVUS EAGLE EYE GOLD 3.5F 85900","code_information":[{"code":"Px0000217639L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3438.0,"discounted_cash":2406.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICRO INTRODUCER 4.5 FR","code_information":[{"code":"Px0000217953L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE PILOT 1010482H","code_information":[{"code":"Px0000218254L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SIZING FLUSH OMNI 5F 70CM H787137097025","code_information":[{"code":"Px0000218259L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":674.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 SIM1","code_information":[{"code":"Px0000218267L","type":"CDM"}],"standard_charges":[{"gross_charge":198.97,"discounted_cash":139.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RCFW 12F 30CM CHECK-FLO G08956","code_information":[{"code":"Px0000218349L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SHUTTL 8FR .038 90CM HC G12836","code_information":[{"code":"Px0000218830L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 10FR 23CM 401023M","code_information":[{"code":"Px0000218866L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MIXER CEM KYPHON W/KYPHX HV-R C01B","code_information":[{"code":"Px0000219208L","type":"CDM"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SR1 CRV 8.5FR 60CM 406854","code_information":[{"code":"Px0000219238L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SR4 CRV 8.5FR 60CM","code_information":[{"code":"Px0000219240L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ 7X40MMX75CM CQ7574","code_information":[{"code":"Px0000219264L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE PROWATER .014 180 AGH146000","code_information":[{"code":"Px0000219404L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE GRANDSLAM .014 180 12781-01 AG141002","code_information":[{"code":"Px0000219405L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PEELWY 22FR .038 13CM G04096","code_information":[{"code":"Px0000219489L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIATORR 10X5 PTB8105275","code_information":[{"code":"Px0000219972L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13176.0,"discounted_cash":9223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ENPROS VIATORR 10X6CM PTB8106275","code_information":[{"code":"Px0000219973L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13176.0,"discounted_cash":9223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIATORR 10X7 PTB8107275","code_information":[{"code":"Px0000219974L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13176.0,"discounted_cash":9223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ENPROS VIATORR 10X8CM PTB8108275","code_information":[{"code":"Px0000219975L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13176.0,"discounted_cash":9223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT WALSTENT 9F 16M/40M 75CM","code_information":[{"code":"Px0000219997L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3557.0,"discounted_cash":2489.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET RETRIEVAL GUNTHER TULIP G13287","code_information":[{"code":"Px0000220009L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH FLEXR 10FR .038 40CM RB G32233","code_information":[{"code":"Px0000220011L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE RDC 7FR 55CM 77821255","code_information":[{"code":"Px0000220975L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT PERCLOSE PROGLIDE 6FR 1267303","code_information":[{"code":"Px0000221040L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.2,"discounted_cash":609.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT 1ST FRACTURE EXPRESS 10/2 KPE1001","code_information":[{"code":"Px0000221561L","type":"CDM"}],"standard_charges":[{"gross_charge":8718.0,"discounted_cash":6102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE BONE BIOPSY EXPRESS F07A","code_information":[{"code":"Px0000221565L","type":"CDM"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT MINIVISION RX 2.0 X 12MM 100782112","code_information":[{"code":"Px0000221807L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT MINIVISION RX 2.25 X 12M 100782212","code_information":[{"code":"Px0000221813L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 16FR 038 30CM G09691","code_information":[{"code":"Px0000221922L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RENEGADE HI/FLO 150CM","code_information":[{"code":"Px0000222295L","type":"CDM"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":868.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X38X80 85402","code_information":[{"code":"Px0000222538L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X59X80 85403","code_information":[{"code":"Px0000222539L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X38X80 85404","code_information":[{"code":"Px0000222540L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6831.0,"discounted_cash":4781.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X59X80 85405","code_information":[{"code":"Px0000222541L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH MAHURKAR 16CM 8888345611","code_information":[{"code":"Px0000222549L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.63,"discounted_cash":334.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH MAHURKAR 20CM 8888345629","code_information":[{"code":"Px0000222550L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.61,"discounted_cash":334.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE MIRCLBRO 3 .014/180 AG14M050","code_information":[{"code":"Px0000223016L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE MIRCLBRO 6 .014/180 AG14M060","code_information":[{"code":"Px0000223018L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 500-700 2ML S620GH","code_information":[{"code":"Px0000223929L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.94,"discounted_cash":691.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 300-500 2ML S420GH","code_information":[{"code":"Px0000223930L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.94,"discounted_cash":691.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 100-300 2ML S220GH","code_information":[{"code":"Px0000223931L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH-L PICC POLY SL 26GA 30CM 384539","code_information":[{"code":"Px0000224552L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 5X38X80 85400","code_information":[{"code":"Px0000227404L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6831.0,"discounted_cash":4781.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 9X38X80 85408","code_information":[{"code":"Px0000227406L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 9X59X80C 85409","code_information":[{"code":"Px0000227407L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE ASAHI MIRACLBRO 300 3 AG14M350","code_information":[{"code":"Px0000227456L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE ASAHI MIRACLBRO 300 6 AG14M360","code_information":[{"code":"Px0000227457L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE ASAHI CONFIANZA 300 AG143390","code_information":[{"code":"Px0000227458L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET TRACH INTRO CIAGLIA 26F G13166","code_information":[{"code":"Px0000227470L","type":"CDM"}],"standard_charges":[{"gross_charge":2137.0,"discounted_cash":1495.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE 3MM J 035 X 150","code_information":[{"code":"Px0000228069L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":559.68,"discounted_cash":391.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CUTTING PERI 5X2X135 M001PCB50201350","code_information":[{"code":"Px0000228074L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.0,"discounted_cash":1483.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISION RX 3.0 X 28MM 100784828","code_information":[{"code":"Px0000228423L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISION RX 4.0 X 18MM 100785018","code_information":[{"code":"Px0000228428L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE BMW .014-300 1001782-HC 1001782HC","code_information":[{"code":"Px0000228538L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RENEGADE HI/FLO 135CM M001182880","code_information":[{"code":"Px0000228614L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":868.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT .014 10/40 ACCULINK IIRX 101134240","code_information":[{"code":"Px0000228730L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.9,"discounted_cash":3737.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT .014 6-8/30 ACCULINKIIRX 101134330","code_information":[{"code":"Px0000228731L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6444.0,"discounted_cash":4510.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT .014 6-8/40 ACCULINKIIRX 101134340","code_information":[{"code":"Px0000228732L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6022.0,"discounted_cash":4215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT .014 7-10/30ACCULINKIIRX 101134430","code_information":[{"code":"Px0000228733L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.9,"discounted_cash":3737.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT .014 7-10/40ACCULINKIIRX 101134440","code_information":[{"code":"Px0000228734L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.9,"discounted_cash":3737.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRC 4.0X20MMX135CM 100818920","code_information":[{"code":"Px0000228790L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRC 5.0X20MMX135CM MULT 100819320","code_information":[{"code":"Px0000228791L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRC 6.0X20MMX135CM 100819720","code_information":[{"code":"Px0000228792L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRAC 7 X 20MM 100820120","code_information":[{"code":"Px0000228793L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRAC 4 X 30MM 100818930","code_information":[{"code":"Px0000228794L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRAC 5 X 30MM 100819330","code_information":[{"code":"Px0000228795L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRAC 4 X 40MM 100818940","code_information":[{"code":"Px0000228797L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRAC 5 X 40MM 100819340","code_information":[{"code":"Px0000228798L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRAC 6 X 40MM 100819740","code_information":[{"code":"Px0000228799L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE MIRAGE 008 200CM 1030608","code_information":[{"code":"Px0000228857L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.0,"discounted_cash":1101.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN HYPERFORM OCC 4X7 150CM 1044470","code_information":[{"code":"Px0000228859L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3769.0,"discounted_cash":2638.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN HYPERFORM OCC 7X7 150CM 1044770","code_information":[{"code":"Px0000228860L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3769.0,"discounted_cash":2638.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN HYPERGLIDE OCC 4X10 150CM 1044113","code_information":[{"code":"Px0000228862L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3226.0,"discounted_cash":2258.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CUTTING PERI 5X2X90 M001PCB5020900","code_information":[{"code":"Px0000228876L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CUTTING PERI 6X2X90 M001PCB6020900","code_information":[{"code":"Px0000228877L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CUTTING PERI 7X2X90 M001PCB7020900","code_information":[{"code":"Px0000228878L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAABE 8FR .038 55CM RB G12242","code_information":[{"code":"Px0000228940L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 14CM 6MM G26994","code_information":[{"code":"Px0000229482L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE COR WHISPER J 190CM 1005357HJ","code_information":[{"code":"Px0000229569L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP 7FR DUO-DECA MC LW 401908","code_information":[{"code":"Px0000229793L","type":"CDM"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":3265.17,"discounted_cash":2285.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE HT IRONMAN EXCHANGE 1001311","code_information":[{"code":"Px0000229897L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CEREB 5FR 125CM .038 VERT G12170","code_information":[{"code":"Px0000230661L","type":"CDM"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP 7FR DUO-DECA SLC LW 401904","code_information":[{"code":"Px0000231029L","type":"CDM"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":3265.17,"discounted_cash":2285.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP 6FR DECA MS LIVEWIRE 401575","code_information":[{"code":"Px0000231145L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.05,"discounted_cash":924.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELECTRODE CATH 6FR QUAD JSN 401430","code_information":[{"code":"Px0000231814L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.69,"discounted_cash":416.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CENTESIS ONE-STEP 5FR 10C OSC5F10","code_information":[{"code":"Px0000231846L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE COR PILOT HT 200 190CM J 1010482HJ","code_information":[{"code":"Px0000232091L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP SUPR 5FR QUAD CRD 401441","code_information":[{"code":"Px0000232138L","type":"CDM"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRACH VALVE PASSY MUIR PMV007","code_information":[{"code":"Px0000232900L","type":"CDM"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE CORONARY 300CM BMW UNIV 1009661","code_information":[{"code":"Px0000233335L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 180CM AES G03330","code_information":[{"code":"Px0000233884L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH KCFW5.03855RB-RAABE G13009","code_information":[{"code":"Px0000234382L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE PLATINUM ST018 180 M001466040","code_information":[{"code":"Px0000235172L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE CHOICE PT EX SUP 300CM H74912155012","code_information":[{"code":"Px0000235648L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE 0.014 BMW 182CM I 1001780HC","code_information":[{"code":"Px0000235674L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE SPARTA .014 300CM 1005203","code_information":[{"code":"Px0000235867L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":559.68,"discounted_cash":391.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE DESTIN 6FRX90C RSC01","code_information":[{"code":"Px0000236429L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE RDC 7FR .081 55CM","code_information":[{"code":"Px0000236485L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FLUSH 5FR 90CM .035 PIG","code_information":[{"code":"Px0000237137L","type":"CDM"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE ASAHI 4.5 .014 300CM","code_information":[{"code":"Px0000237449L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":444.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE AMPLATZER J .035/260 9GW002","code_information":[{"code":"Px0000238296L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PEG SAFETY PULL 20FR ZYLOCAINE M00566461","code_information":[{"code":"Px0000238337L","type":"CDM"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .014 X 135CM 518032","code_information":[{"code":"Px0000238451L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PEELAWAY 18FR .038 13CM G06444","code_information":[{"code":"Px0000238758L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE MAGIC TORQUE .035X180CM M001465911","code_information":[{"code":"Px0000238801L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.34,"discounted_cash":185.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE HEADLNR .016-200","code_information":[{"code":"Px0000238822L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.95,"discounted_cash":979.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE XPEDION .010 200CM 1030605200","code_information":[{"code":"Px0000238824L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE HEADLNR .016X200 90D","code_information":[{"code":"Px0000238873L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.95,"discounted_cash":979.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE ROTA FLOPPY 325 CM H802228240022","code_information":[{"code":"Px0000238874L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 24CM CL07624","code_information":[{"code":"Px0000239750L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE .035/150/8 ANG GR3507","code_information":[{"code":"Px0000240830L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.28,"discounted_cash":243.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 4FR 10CM RSS402","code_information":[{"code":"Px0000240869L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.86,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE STRT TAPER 5FR 65C CG505","code_information":[{"code":"Px0000240892L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 6FR PIG-145 08641-41 H74908641412","code_information":[{"code":"Px0000240899L","type":"CDM"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDECATH 4FR 100CM ANGLE TAPER CG416","code_information":[{"code":"Px0000240903L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.32,"discounted_cash":208.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STARTER BENTSON 035 150CM M001491451","code_information":[{"code":"Px0000240964L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.3,"discounted_cash":91.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SNARE GOOSENECK 10MM GN1000","code_information":[{"code":"Px0000241685L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN 19FR ARTERIAL FEMORAL CB96535019","code_information":[{"code":"Px0000243596L","type":"CDM"}],"standard_charges":[{"gross_charge":1428.0,"discounted_cash":999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN 17FR ARTERIAL FEMORAL CB96535017","code_information":[{"code":"Px0000243597L","type":"CDM"}],"standard_charges":[{"gross_charge":1428.0,"discounted_cash":999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDE WIRE 0.018IN 150CM GR1805","code_information":[{"code":"Px0000244009L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.96,"discounted_cash":210.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 7FR 24CM CL07724","code_information":[{"code":"Px0000246866L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.84,"discounted_cash":195.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 8FR 24CM CL07824","code_information":[{"code":"Px0000246867L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.84,"discounted_cash":195.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ENPROS WSTNT 10FR 22X45M H965404510","code_information":[{"code":"Px0000247015L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TRANSS SL1 8.5F 406849","code_information":[{"code":"Px0000247019L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE BHW H.W. .014 190CM 1000462H","code_information":[{"code":"Px0000247230L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH FLEXOR BLKN RB 6F 40CM G10383","code_information":[{"code":"Px0000247246L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IR TEMPO CATH BERENSTEIN 4FR","code_information":[{"code":"Px0000247410L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IR PALMAZ XL STENT 40MM P4010","code_information":[{"code":"Px0000247529L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3465.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IR PASPORT ELITE KIT 21459024","code_information":[{"code":"Px0000247531L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.0,"discounted_cash":947.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 11F RSS104","code_information":[{"code":"Px0000247877L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INF UNIFUSE 30/135CM 5FR H787124018145","code_information":[{"code":"Px0000247926L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SCHON XL ACUTE HD 24CM 10800703","code_information":[{"code":"Px0000248069L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV ARROW MAC DL 7FR 20CM","code_information":[{"code":"Px0000248170L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE AVE L 6FR EBU35 LA6EBU35","code_information":[{"code":"Px0000248183L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE AVE L 6FR EBU375 LA6EBU375","code_information":[{"code":"Px0000248184L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE OBTUR 8FR","code_information":[{"code":"Px0000248351L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ENDOTAK RELIANCE AF 137","code_information":[{"code":"Px0000248508L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":4509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ENDOTAK RELAINCE AF 138","code_information":[{"code":"Px0000248509L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":4509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE 10X30 6FR 80CM SERB65103080","code_information":[{"code":"Px0000248591L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI PRTG 6FR 10X40MMX80 SERB65104080","code_information":[{"code":"Px0000248592L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.32,"discounted_cash":1011.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE 10X60 6FR 80CM SERB65106080","code_information":[{"code":"Px0000248593L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SHTL 6FR .038 90CM HC F G31138","code_information":[{"code":"Px0000248911L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNILINK 7X28 80CM 100818028","code_information":[{"code":"Px0000248973L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4387.0,"discounted_cash":3070.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DAWSON-MUELLER 12FR 25CM G10435","code_information":[{"code":"Px0000249209L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT GRAFT BALLOON CATH REL46","code_information":[{"code":"Px0000249250L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1359.0,"discounted_cash":951.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE 9X30 6FR 80CM SERB65093080","code_information":[{"code":"Px0000249272L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI PRTG 6FR 9X40MMX80 SERB65094080","code_information":[{"code":"Px0000249273L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE 9X60 6FR 80CM SERB65096080","code_information":[{"code":"Px0000249274L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 6X16X80 85442","code_information":[{"code":"Px0000249289L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP EXTR 1 CRV SHRT 227F1","code_information":[{"code":"Px0000249337L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":2713.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP XTRA 3 CRV MD 227F3","code_information":[{"code":"Px0000249338L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":2713.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SHEATH INTRODUCER 7FR 504607X","code_information":[{"code":"Px0000249577L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .038X150CM GR3806","code_information":[{"code":"Px0000249951L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.9,"discounted_cash":215.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE STRT .038X150CM GR3801","code_information":[{"code":"Px0000249952L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.9,"discounted_cash":215.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH WIRE ASAHI PRO J TIP .014 AGH146300J","code_information":[{"code":"Px0000250237L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CUTTING PERI 6X2X135 M001PCB60201350","code_information":[{"code":"Px0000250543L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.0,"discounted_cash":1483.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CUTTING PERIPHERAL 8X2X135 M001PCB80201350","code_information":[{"code":"Px0000250545L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.0,"discounted_cash":1483.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISION RX 2.75 X 12MM 100784712","code_information":[{"code":"Px0000250549L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TRUFILL PUSHER 632774X","code_information":[{"code":"Px0000250563L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1816.0,"discounted_cash":1271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE ENVOY MPD 90 CM 5FR 55625890","code_information":[{"code":"Px0000250566L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":994.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 100CM .038 CG413","code_information":[{"code":"Px0000250600L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH QUAD JSN 5FR","code_information":[{"code":"Px0000250603L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.69,"discounted_cash":416.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HEMOGLID STAR 14.5/28CM STR","code_information":[{"code":"Px0000251017L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE ROSEN 035 260CM 1.5MM G01253","code_information":[{"code":"Px0000251786L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH BALKN 7FR .038 40CM RB G10384","code_information":[{"code":"Px0000252551L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 15CM G09492","code_information":[{"code":"Px0000252702L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE ANGLED .025 260CM T GR2506","code_information":[{"code":"Px0000252722L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE STANDARD .035X260CM GR3504","code_information":[{"code":"Px0000252814L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DAIG 5FR QUAD CRD-2 401860","code_information":[{"code":"Px0000252978L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.69,"discounted_cash":416.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DELIVERY SYS BRAVO PH CAPSULE FGS0312","code_information":[{"code":"Px0000253123L","type":"CDM"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":739.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CUT PERIPH OTW 6MMX2X50CM M001PCB6020500","code_information":[{"code":"Px0000253364L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.0,"discounted_cash":1483.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 120CM STRT CG414","code_information":[{"code":"Px0000253633L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 120CM ANGLED CG417","code_information":[{"code":"Px0000253634L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE PROWATER .014 300CM AGH146300","code_information":[{"code":"Px0000253846L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN WDG PRESS 6FR 90CM 6714","code_information":[{"code":"Px0000253963L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HEMOSTAR ST 14.5FR 23CM","code_information":[{"code":"Px0000254003L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HEMOSTAR ST 14.5FR 19CM 5833690","code_information":[{"code":"Px0000254004L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 5X22X120 85451","code_information":[{"code":"Px0000254041L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X22X120 85455","code_information":[{"code":"Px0000254042L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6831.0,"discounted_cash":4781.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X38X80 85406","code_information":[{"code":"Px0000254048L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X59X80 85407","code_information":[{"code":"Px0000254049L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 5X22X80 85441","code_information":[{"code":"Px0000254050L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6831.0,"discounted_cash":4781.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MERCI 9FR 95CM 90074","code_information":[{"code":"Px0000254057L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3798.22,"discounted_cash":2658.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FLEXTOME CUT MONO 2.5X10 H749CBM3250100","code_information":[{"code":"Px0000254219L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3473.0,"discounted_cash":2431.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MATRIX2 STD SR 8 X 30 492830SR","code_information":[{"code":"Px0000254249L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9906.0,"discounted_cash":6934.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE TRANSEND FLOPPY .014 300 M003468150","code_information":[{"code":"Px0000254349L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1825.57,"discounted_cash":1277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI PRTG 6FR 14X40MMX80 SERB65144080","code_information":[{"code":"Px0000254384L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE 6FR AL3.0 H749086411002","code_information":[{"code":"Px0000254856L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EMBOL OVR/WIRE 3FR 80CM 12TLW803F","code_information":[{"code":"Px0000254952L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MHRKR W/CRV TL 12FR 13CM","code_information":[{"code":"Px0000255265L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.61,"discounted_cash":334.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":242.28,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STIFF STR TERUMO 035X180 GS3503","code_information":[{"code":"Px0000255625L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ANGIOJET DVX 6FR 90CM 105420001","code_information":[{"code":"Px0000255893L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8450.0,"discounted_cash":5915.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE LQST STR XSTIF 260X11 G31453","code_information":[{"code":"Px0000256378L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.53,"discounted_cash":462.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAABE 7FR .038 70CM RB G11635","code_information":[{"code":"Px0000257143L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PEELAWAY 10F G01980","code_information":[{"code":"Px0000257212L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PEELAWAY 12F G06492","code_information":[{"code":"Px0000257213L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC D-STAT FLOWABLE 4000","code_information":[{"code":"Px0000257859L","type":"CDM"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SR3 8F 406847","code_information":[{"code":"Px0000258037L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SLO 8.0FR 406948","code_information":[{"code":"Px0000258038L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.96,"discounted_cash":534.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT ONYX 18 LIQUID EMBOLIC 1057100060","code_information":[{"code":"Px0000258073L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7642.0,"discounted_cash":5349.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT ONYX 34 LIQUID EMBOLIC 1057100080","code_information":[{"code":"Px0000258074L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7642.0,"discounted_cash":5349.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO MARATHON 170CM 1055055","code_information":[{"code":"Px0000258075L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3129.0,"discounted_cash":2190.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT CRYO NEEDLE ICEROD 90 DEG","code_information":[{"code":"Px0000258422L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3671.0,"discounted_cash":2569.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IABP 7.5FR 40CC 068400048001U","code_information":[{"code":"Px0000258612L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2340.0,"discounted_cash":1638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLUDER AMPLATZER SEPTAL 10MM 9ASD010","code_information":[{"code":"Px0000258675L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":19830.0,"discounted_cash":13881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CSV 6FR 80CM BVCS6180","code_information":[{"code":"Px0000258744L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .035 X 135CM 518037","code_information":[{"code":"Px0000259236L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LASER VITESSE RX 1.4 MM 114009","code_information":[{"code":"Px0000259239L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":7400.0,"discounted_cash":5180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LASER VITESSE RX 0.9 MM 110004","code_information":[{"code":"Px0000259240L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":8052.0,"discounted_cash":5636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 100CM H1 CG404","code_information":[{"code":"Px0000259246L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.32,"discounted_cash":208.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE GT .018 DBL ANG","code_information":[{"code":"Px0000259269L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.16,"discounted_cash":728.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT XACT STR 8X30MM 8209201","code_information":[{"code":"Px0000259353L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6022.0,"discounted_cash":4215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROTID XACT 10X30 ST 8209801","code_information":[{"code":"Px0000259355L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5788.0,"discounted_cash":4051.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT XACT TPR 8X30MM 8209101","code_information":[{"code":"Px0000259356L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6022.0,"discounted_cash":4215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROTID XACT 9-7X30 TPR 8208701","code_information":[{"code":"Px0000259357L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5788.0,"discounted_cash":4051.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROTID XACT 10-8X30 TPR 8209701","code_information":[{"code":"Px0000259358L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.9,"discounted_cash":3737.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT XACT TPR 8X40MM 8209001","code_information":[{"code":"Px0000259359L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.9,"discounted_cash":3737.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT XACT TPR 9X7X40MM 8208601","code_information":[{"code":"Px0000259360L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.9,"discounted_cash":3737.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROTID XACT 10-8X40 TPR 8209601","code_information":[{"code":"Px0000259361L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.9,"discounted_cash":3737.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPHINCTEROTOME HYDRA RX44 20MM M00583040","code_information":[{"code":"Px0000259413L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"discounted_cash":1029.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE FIXED J .035/260 M001491211","code_information":[{"code":"Px0000259714L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE MAGIC TRQ .035X260CM M001465921","code_information":[{"code":"Px0000259861L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.34,"discounted_cash":185.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL FIBERED VORTEX 3MM-7MM M0013733071","code_information":[{"code":"Px0000259866L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE COR WHISPER J 300CM 1005359HJ","code_information":[{"code":"Px0000259906L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE BMW J 300CM 1001782J","code_information":[{"code":"Px0000259907L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 6 60XLTCD","code_information":[{"code":"Px0000259993L","type":"CDM"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 6 60XLTCP","code_information":[{"code":"Px0000259994L","type":"CDM"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRACH XLT UNCUFF PROX 6MM 60XLTUP","code_information":[{"code":"Px0000259995L","type":"CDM"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 8 80XLTCP","code_information":[{"code":"Px0000259997L","type":"CDM"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 10 FASTCATH 12CM 406120","code_information":[{"code":"Px0000260316L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SHUTL 6.5 FR 125 CM VTK SCBR6535125PNSVTKSHT G36362","code_information":[{"code":"Px0000260827L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE 15CM TAPR .035 145CM G00701","code_information":[{"code":"Px0000261108L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE MIRACLBRO12 .014/180 AG14M070","code_information":[{"code":"Px0000261136L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE CONFIANZA12 .014/180 AGH143091","code_information":[{"code":"Px0000261137L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL/PLUG AMPLATZER 8MM/7MM 9PLUG008","code_information":[{"code":"Px0000261147L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2654.0,"discounted_cash":1857.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2654.0,"discounted_cash":1857.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL/PLUG AMPLATZER 12MM/8MM 9PLUG012","code_information":[{"code":"Px0000261149L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2840.0,"discounted_cash":1988.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL/PLUG AMPLATZER 14MM/8MM 9PLUG014","code_information":[{"code":"Px0000261150L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2840.0,"discounted_cash":1988.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL/PLUG AMPLATZER 16MM/8MM 9PLUG016","code_information":[{"code":"Px0000261151L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2654.0,"discounted_cash":1857.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH OUTBACK RE-ENTRY 5.9FR 12 OTB42120","code_information":[{"code":"Px0000261643L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7156.0,"discounted_cash":5009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GDW .035-.038 X 150 ANGLED XR GR3506","code_information":[{"code":"Px0000261742L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.9,"discounted_cash":215.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ZIPWIRE .035IN 180CM STD ANG M00146152B1","code_information":[{"code":"Px0000262000L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ZIPWIRE .035IN 260CM STD ANG M00146154B1","code_information":[{"code":"Px0000262001L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ZIPWIRE .035IN 180CM STIF ANG M00146308B1","code_information":[{"code":"Px0000262015L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV IHI ML 16CM 7FR KT","code_information":[{"code":"Px0000262069L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MICRONESTER .018 14CM 3MM","code_information":[{"code":"Px0000262172L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP SUPR 5FR QUAD CRD -REP 401441RH","code_information":[{"code":"Px0000262612L","type":"CDM"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":268.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DAIG 5FR QUAD CRD-2 -REP 401860RH","code_information":[{"code":"Px0000262614L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.61,"discounted_cash":231.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 7 70XLTCP","code_information":[{"code":"Px0000262983L","type":"CDM"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 11F 10CM RSS103","code_information":[{"code":"Px0000263214L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STRAIGHT TERUMO .035 150 GR3501","code_information":[{"code":"Px0000263466L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.9,"discounted_cash":215.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1815.0,"discounted_cash":1270.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PRONTO V3 EXTRACT 5003","code_information":[{"code":"Px0000263563L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1409.14,"discounted_cash":986.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG MR5.0X20MMX135 H74939031502010","code_information":[{"code":"Px0000264007L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING 4X10X135 H74939032401010","code_information":[{"code":"Px0000264013L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING 5X10X135 H74939032501010","code_information":[{"code":"Px0000264014L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URET GLIDEX 8FR 28CM M001245530","code_information":[{"code":"Px0000264069L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE PLAT PLS ST 260CM","code_information":[{"code":"Px0000264079L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.24,"discounted_cash":306.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT DRNGE PLEURX 1000ML 507510","code_information":[{"code":"Px0000264749L","type":"CDM"}],"standard_charges":[{"gross_charge":364.32,"discounted_cash":255.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PERIPH MINIHAWK 6FR 4028 P4028","code_information":[{"code":"Px0000264840L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9018.0,"discounted_cash":6312.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FIXED CURVE 115 CM 6FR-REP","code_information":[{"code":"Px0000265264L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PUMP PAIN ONQ DBL SLVR 270X5IN PM025A","code_information":[{"code":"Px0000265316L","type":"CDM"},{"code":"C9804","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":543.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT 1ST FRACTURE EXPRESS 15/2 KPE1003","code_information":[{"code":"Px0000265390L","type":"CDM"}],"standard_charges":[{"gross_charge":8718.0,"discounted_cash":6102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1815.0,"discounted_cash":1270.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1444.32,"discounted_cash":1011.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X150MMX120CM PRB3508150120","code_information":[{"code":"Px0000266008L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2101.0,"discounted_cash":1470.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE SHT 7X20X80 PRB3507020080","code_information":[{"code":"Px0000266069L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3157.0,"discounted_cash":2209.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR TLS SL 5FR TY","code_information":[{"code":"Px0000266151L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":536.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOSEAL VIP 6F 610130","code_information":[{"code":"Px0000292099L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.6,"discounted_cash":720.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV PWRLINE CUFF SL 5FR KT 0700515","code_information":[{"code":"Px0000292187L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":689.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PWRLINE CUFF DL 6FR 0700615","code_information":[{"code":"Px0000292188L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":746.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MICRONESTER .018 14CM 4MM G26988","code_information":[{"code":"Px0000292196L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY PNEUMOTHORAX AK01500","code_information":[{"code":"Px0000292391L","type":"CDM"}],"standard_charges":[{"gross_charge":612.48,"discounted_cash":428.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PEELAWAY 16FR .038 G02997","code_information":[{"code":"Px0000292416L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE STR TPR 4FR 65CM","code_information":[{"code":"Px0000292485L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE STR TPR 5FR 100CM CG506","code_information":[{"code":"Px0000292486L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OTW 7X80X80","code_information":[{"code":"Px0000292524L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4092.0,"discounted_cash":2864.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED VIABAHN 8 X 10 VBB081002","code_information":[{"code":"Px0000292558L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12161.0,"discounted_cash":8512.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG MR5.0X30MMX80","code_information":[{"code":"Px0000292594L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING OTW 4X2X135 H74939032402010","code_information":[{"code":"Px0000292774L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING OTW 4X8X135 H74939032408010","code_information":[{"code":"Px0000292783L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING OTW 5X4X135 3903250401","code_information":[{"code":"Px0000292786L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG OTW 5X60MMX135 H74939032506010","code_information":[{"code":"Px0000292787L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING OTW 5X8X135 H74939032508010","code_information":[{"code":"Px0000292788L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING OTW 6X2X135","code_information":[{"code":"Px0000292789L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING OTW 6X4X135 H74939032604010","code_information":[{"code":"Px0000292791L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG OTW 7X60MMX135 H74939032706010","code_information":[{"code":"Px0000292797L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG OTW 8X60MMX135","code_information":[{"code":"Px0000292803L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG OTW 9X60MMX135 H74939032906010","code_information":[{"code":"Px0000292808L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG OTW 10X60MMX135 H74939032106010","code_information":[{"code":"Px0000292813L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SIZING FLUSH OMNI 5F100CM","code_information":[{"code":"Px0000293030L","type":"CDM"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC PRE-SHP 2TP 90D 150CM M0031681910","code_information":[{"code":"Px0000293236L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.0,"discounted_cash":1927.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 10X38X80 85420","code_information":[{"code":"Px0000293355L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROPUNCT 5FR NITNL/PLAT SST G43870","code_information":[{"code":"Px0000293604L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STEEL CORE 18LT 018 300CM","code_information":[{"code":"Px0000293751L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CRYO COAXIAL UMBILICAL","code_information":[{"code":"Px0000294097L","type":"CDM"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":507.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PWR PRT TITANIUM 1708000","code_information":[{"code":"Px0000294158L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.0,"discounted_cash":933.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .018 X 135CM 518034","code_information":[{"code":"Px0000294461L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FLEXIMA APD 8FR 27129","code_information":[{"code":"Px0000294475L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV TL 7FX20CM BLUE FLXTIP ML00703","code_information":[{"code":"Px0000294636L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD CAPSURE SENSE 407452","code_information":[{"code":"Px0000294663L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEUROFORM3 4.5 X 20MM SNF34520","code_information":[{"code":"Px0000294811L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":17420.0,"discounted_cash":12194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH UNIFUSE 135C 20C INF 4F H787124018225","code_information":[{"code":"Px0000294814L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":612.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH UNIFUSE 135C 50C INF 5F H787124018165","code_information":[{"code":"Px0000294815L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAABE 9FR .038 55CM RB G36393","code_information":[{"code":"Px0000294871L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TEMPO AQUA4 VER 4FR 125CM SRD6108","code_information":[{"code":"Px0000294881L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LASER TURBO ELITE 1.7MM 417152","code_information":[{"code":"Px0000294924L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":8278.0,"discounted_cash":5794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE GPS 12X40 80CM SERB65124080","code_information":[{"code":"Px0000294995L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE GPS 12X60 80CM","code_information":[{"code":"Px0000294996L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE GPS 14X60 80CM","code_information":[{"code":"Px0000294997L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN 10X8 W/SIDEHOLES VH1008040","code_information":[{"code":"Px0000294999L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10211.0,"discounted_cash":7147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL SET EZ-IO AD 40-UP KG 9001VC005","code_information":[{"code":"Px0000295140L","type":"CDM"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOSEAL VIP 8F 610131","code_information":[{"code":"Px0000295175L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.6,"discounted_cash":720.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE GRANDSLAM 300CM AG141302","code_information":[{"code":"Px0000296282L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SCHON XL ACUTE HD 15CM 10800701","code_information":[{"code":"Px0000296677L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SCHON XL ACUTE HD 20CM 10800702","code_information":[{"code":"Px0000296678L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE SUPER STIFF .035X260CM 80129406","code_information":[{"code":"Px0000296905L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":313.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TWIN-PASS DUAL ACCESS 014 5200","code_information":[{"code":"Px0000297219L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.0,"discounted_cash":1108.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIATORR 10X4","code_information":[{"code":"Px0000297725L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13176.0,"discounted_cash":9223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SL2 CRV 8.5F 62CM","code_information":[{"code":"Px0000297729L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISION OTW 2.75X28MM","code_information":[{"code":"Px0000297816L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.0,"discounted_cash":1904.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DUODENAL WALLFLEX 22X120 M00565030","code_information":[{"code":"Px0000297886L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":10084.0,"discounted_cash":7058.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LANGSTON DUAL PIG 6F 110C 5540","code_information":[{"code":"Px0000298588L","type":"CDM"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RENE 18 STR TIP 130/20 M001181310","code_information":[{"code":"Px0000298589L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1484.0,"discounted_cash":1038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RENE 18 STR TIP 130/30","code_information":[{"code":"Px0000298590L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER AGILIS NXT 408309","code_information":[{"code":"Px0000298598L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 US 863017","code_information":[{"code":"Px0000299264L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH KIT SILVRSOAKER ONQ 10IN W/NDL 8IN PM040A","code_information":[{"code":"Px0000299986L","type":"CDM"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER AGILIS NXT MED 8.5F 408310","code_information":[{"code":"Px0000300012L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 3MM X 6CM M001361500","code_information":[{"code":"Px0000300284L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 4MMX8CM M001361520","code_information":[{"code":"Px0000300285L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 5MMX8CM M001361540","code_information":[{"code":"Px0000300286L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 5MMX15CM M001361550","code_information":[{"code":"Px0000300287L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 6MM X 20CM M001361570","code_information":[{"code":"Px0000300288L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR DL 5FR 3275335","code_information":[{"code":"Px0000300348L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.01,"discounted_cash":315.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR SL 4FR","code_information":[{"code":"Px0000300349L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH DESTIN 6FR 65CM RSP01","code_information":[{"code":"Px0000301944L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.4,"discounted_cash":434.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CABLE ELECTRICAL UMBILICAL","code_information":[{"code":"Px0000302244L","type":"CDM"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE SYNCHRO2 SFT 200 .014 M00326010","code_information":[{"code":"Px0000302455L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.63,"discounted_cash":1374.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TRANSSEPTAL SLO 8.5 407451","code_information":[{"code":"Px0000302469L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.24,"discounted_cash":630.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOP COAXIAL TEMNO EVOL 18X11","code_information":[{"code":"Px0000302527L","type":"CDM"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BRKI 98CM 407207","code_information":[{"code":"Px0000302530L","type":"CDM"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":693.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING NASOJEJUNAL 10FR G22301","code_information":[{"code":"Px0000302627L","type":"CDM"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOP BONE 13GAX10CM G12499","code_information":[{"code":"Px0000302770L","type":"CDM"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 4 X 320 SPD2US040320","code_information":[{"code":"Px0000302984L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":3540.0,"discounted_cash":2478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FCP SPYBITE M00546270","code_information":[{"code":"Px0000303006L","type":"CDM"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MICRONESTER .018 14CM 8MM G26990","code_information":[{"code":"Px0000303597L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT PRECIS PRO RX 7X40 PC0740RXC","code_information":[{"code":"Px0000303623L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":9768.0,"discounted_cash":6837.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT PRECIS PRO RX 8X30 PC0830RXC","code_information":[{"code":"Px0000303625L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":9768.0,"discounted_cash":6837.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT PRECIS PRO RX 8X40 PC0840RXC","code_information":[{"code":"Px0000303626L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8111.0,"discounted_cash":5677.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PRECISE RX PRO 9X30 PC0930RXC","code_information":[{"code":"Px0000303628L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":9768.0,"discounted_cash":6837.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CAROT PRECIS PRO RX 9X40 PC0940RXC","code_information":[{"code":"Px0000303629L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9768.0,"discounted_cash":6837.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER GUIDEWIRE EPD 5MM 501814RMC","code_information":[{"code":"Px0000303634L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":6383.0,"discounted_cash":4468.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER GUIDEWIRE EPD 6MM 601814RMC","code_information":[{"code":"Px0000303635L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":6383.0,"discounted_cash":4468.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X80MMX120CM PRB3506080120","code_information":[{"code":"Px0000303668L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X80MMX120CM PRB3507080120","code_information":[{"code":"Px0000303669L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH KIT SILVRSOAKER ONQ 7.5IN W/NDL 8IN PM050A","code_information":[{"code":"Px0000303828L","type":"CDM"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":395.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SILVERHAWK EXL P4044","code_information":[{"code":"Px0000303982L","type":"CDM"}],"standard_charges":[{"gross_charge":9018.0,"discounted_cash":6312.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X60MMX120CM PRB3506060120","code_information":[{"code":"Px0000304049L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 6 X 12MM X 80CM","code_information":[{"code":"Px0000304421L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 6 X 17MM X 80CM PXB350617080","code_information":[{"code":"Px0000304422L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 6 X 27MM X 80CM PXB350627080","code_information":[{"code":"Px0000304423L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 6 X 37MM X 80CM PXB350637080","code_information":[{"code":"Px0000304424L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 7 X 17MM X 80CM PXB350717080","code_information":[{"code":"Px0000304427L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 7 X 27MM X 80CM PXB350727080","code_information":[{"code":"Px0000304428L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 7 X 37MM X 80CM PXB350737080","code_information":[{"code":"Px0000304429L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 17MM X 80CM PXB350817080","code_information":[{"code":"Px0000304431L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 27MM X 80CM PXB350827080","code_information":[{"code":"Px0000304432L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 37MM X 80CM PXB350837080","code_information":[{"code":"Px0000304433L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 57MM X 80CM PXB350857080","code_information":[{"code":"Px0000304434L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.54,"discounted_cash":1061.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHERES LC 100-300 YELLOW VE220GS","code_information":[{"code":"Px0000304669L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":3458.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE WHSPR EXT SUPP .014X190CM 1011834H","code_information":[{"code":"Px0000304700L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VIATRAC 4.5X20MMX135CM 100819120","code_information":[{"code":"Px0000304888L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE SPARTACOR .014 10X300CM 1005206","code_information":[{"code":"Px0000305246L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STEELCORE J .018INX190CM","code_information":[{"code":"Px0000305247L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STEELCORE J .018INX300CM","code_information":[{"code":"Px0000305248L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE VBT 6FR 67019055","code_information":[{"code":"Px0000305265L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPAIR KIT BROVIAC 4.2FR 601610","code_information":[{"code":"Px0000305371L","type":"CDM"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":591.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PROWLER SELECT PLS ST TIP 606S255X","code_information":[{"code":"Px0000305394L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2623.0,"discounted_cash":1836.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACHABLE AZUR 4MMX10CM 45480410","code_information":[{"code":"Px0000305562L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2764.0,"discounted_cash":1934.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONTROLLER DETACHMENT 454001","code_information":[{"code":"Px0000305564L","type":"CDM"}],"standard_charges":[{"gross_charge":1000.56,"discounted_cash":700.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP CRD2 6FX5MM 402004 402004","code_information":[{"code":"Px0000305615L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.69,"discounted_cash":416.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STEEL CORE 18 .018 190CM 1003281","code_information":[{"code":"Px0000305619L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE STEEL CORE 18 .018 300CM 1003282","code_information":[{"code":"Px0000305620L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DEL TORQ 45 AMPLATZER 8F 9ITV08F4580","code_information":[{"code":"Px0000305653L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":1628.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT SMART CT W/ VORTEX TECH H787CT75STSDVI1","code_information":[{"code":"Px0000306379L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1404.0,"discounted_cash":982.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI HERCU 5X15MMX135CM 101149315","code_information":[{"code":"Px0000306470L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5673.0,"discounted_cash":3971.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI HERCU 7X18MMX135CM 101150518","code_information":[{"code":"Px0000306492L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5673.0,"discounted_cash":3971.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 5X40MMX120CM PRB3505040120","code_information":[{"code":"Px0000306788L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 5X80MMX120CM PRB3505080120","code_information":[{"code":"Px0000306790L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 5X100MMX120CM PRB3505100120","code_information":[{"code":"Px0000306791L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LASER TURBO ELITE 1.4MM 414151","code_information":[{"code":"Px0000306842L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":9420.0,"discounted_cash":6594.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LASER TURBO ELITE 2.0MM 420006","code_information":[{"code":"Px0000306843L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":9420.0,"discounted_cash":6594.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .014 X 150CM 518065","code_information":[{"code":"Px0000306847L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .035 X 65CM 518066","code_information":[{"code":"Px0000306848L","type":"CDM"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET THRMBCTMY SPIRO 4F 135CM 106553001","code_information":[{"code":"Px0000306902L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5720.0,"discounted_cash":4004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH DEST PINN 7FR 65CM RSP02","code_information":[{"code":"Px0000307133L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.4,"discounted_cash":434.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE ROSEN 035 145CM 1.5M","code_information":[{"code":"Px0000307135L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN GATEWAY OTW 2.25 X 9.0 MM 207220922","code_information":[{"code":"Px0000307374L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2934.0,"discounted_cash":2053.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO PRE-SHAPE J 150 6CM M0031681920","code_information":[{"code":"Px0000307434L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.0,"discounted_cash":1927.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC PRE-SHP 2TP 45D 150CM M0031681900","code_information":[{"code":"Px0000307435L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.0,"discounted_cash":1927.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ANGIO 5FR AMPLATZ L1 H74908526962","code_information":[{"code":"Px0000307553L","type":"CDM"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBING ASPIRATION STRL PST1","code_information":[{"code":"Px0000307770L","type":"CDM"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":953.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANISTER SYS PENUMBRA PAPS1","code_information":[{"code":"Px0000307771L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1122.0,"discounted_cash":785.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 COIL 864017","code_information":[{"code":"Px0000307940L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CEREB 5FR 125CM .035 HI","code_information":[{"code":"Px0000308211L","type":"CDM"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 TEGT G12179","code_information":[{"code":"Px0000308303L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET NEFF ACCESS CHIBA 21GA NT G08426","code_information":[{"code":"Px0000308328L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URO MACLOC 8.5FR 22CM G48173","code_information":[{"code":"Px0000308338L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URO MACLOC 8.5FR 26CM G48180","code_information":[{"code":"Px0000308339L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URET AMPLATZ 8.5FR 12CM G09989","code_information":[{"code":"Px0000308345L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URET AMPLATZ 8.5FR 20CM G09865","code_information":[{"code":"Px0000308346L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL MYREYE .035 4CM 3MM","code_information":[{"code":"Px0000308347L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CHAIT TRAPDOR CECOSTOMY L G12685","code_information":[{"code":"Px0000308372L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.31,"discounted_cash":740.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CHAIT TRAPDOR CECOSTOMY M G36392","code_information":[{"code":"Px0000308373L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAABE 6FR .038 90CM RB G12266","code_information":[{"code":"Px0000308388L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAABE 7FR .038 90CM RB G11634","code_information":[{"code":"Px0000308391L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH W/ WIRE 14FR .038 13CM G08024","code_information":[{"code":"Px0000308407L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":298.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH MULLINS 9FR 038 75CM RB G09190","code_information":[{"code":"Px0000308422L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT MICROPUNCTURE TRANS NIT 4F","code_information":[{"code":"Px0000308428L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VASC ZLVR 5F 125CM 10-40 G43791","code_information":[{"code":"Px0000308496L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.6,"discounted_cash":2316.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VASC ZLVR 5F 125CM 10-60 G43792","code_information":[{"code":"Px0000308497L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.6,"discounted_cash":2316.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VASC ZLVR 5F 125CM 10-80","code_information":[{"code":"Px0000308498L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.6,"discounted_cash":2316.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 038 145CM COO G02324","code_information":[{"code":"Px0000308582L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.88,"discounted_cash":139.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE .025 260CM 3MM G00471","code_information":[{"code":"Px0000308587L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TRANSS SL3 8.5F","code_information":[{"code":"Px0000308606L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROBE FIAPC 2.3MM 6.9FR 20132214","code_information":[{"code":"Px0000308688L","type":"CDM"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":704.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER MICRO-EZ 5FR 7CM 0928950","code_information":[{"code":"Px0000308935L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOP COAXIAL TEMNO EVOL 20X15","code_information":[{"code":"Px0000308951L","type":"CDM"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FOX SV .018 2X20X150","code_information":[{"code":"Px0000308968L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FOX SV .018 2X40X150","code_information":[{"code":"Px0000308970L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":8689.0,"discounted_cash":6082.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FOX SV .018 2X80X150","code_information":[{"code":"Px0000308972L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FOX SV .018 3X40X150","code_information":[{"code":"Px0000308984L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":8689.0,"discounted_cash":6082.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FOX SV .018 3X80X150","code_information":[{"code":"Px0000308986L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FOX SV .018 3X100X150","code_information":[{"code":"Px0000308987L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FOX SV .018 4X120X150","code_information":[{"code":"Px0000308996L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ACUITY SPIRAL 4591","code_information":[{"code":"Px0000309038L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3596.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 3MMX12CM M001361510","code_information":[{"code":"Px0000309287L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 4MMX15CM M001361530","code_information":[{"code":"Px0000309288L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI WSTNT UNCVR 10X60M M00570640","code_information":[{"code":"Px0000309423L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4880.34,"discounted_cash":3416.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WALLSTENT MV UNCOVERED 10X80 M00570650","code_information":[{"code":"Px0000309424L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6905.0,"discounted_cash":4833.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRSG VAC GRANUFM SIL SENSA MED M827509610","code_information":[{"code":"Px0000309575L","type":"CDM"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL CORE BIOP DEVICE CELERO12","code_information":[{"code":"Px0000309593L","type":"CDM"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROBE FIAPC 2.3MM CIRCUMFERENC 20132218","code_information":[{"code":"Px0000309706L","type":"CDM"}],"standard_charges":[{"gross_charge":1035.0,"discounted_cash":724.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT XIENCE RX 2.5X12MM 100953912","code_information":[{"code":"Px0000309956L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6774.0,"discounted_cash":4741.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT XIENCE RX 4.0X28MM 100954328","code_information":[{"code":"Px0000309984L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6774.0,"discounted_cash":4741.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE TRACH XLT UNCUFF DST 6MM 60XLTUD","code_information":[{"code":"Px0000310908L","type":"CDM"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL MYREYE .038 5CM 8MM","code_information":[{"code":"Px0000311087L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION .035 3CM 3MM","code_information":[{"code":"Px0000311091L","type":"CDM"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION .035 3CM 4MM G42409","code_information":[{"code":"Px0000311092L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH PERITONEAL PLEURX 509000B","code_information":[{"code":"Px0000311242L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1357.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE HIWIRE ANG .035 180 G36284","code_information":[{"code":"Px0000311367L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD VENTRIC CAPSURE BPLR 58CM 407458","code_information":[{"code":"Px0000311397L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ATR/VENT BIPLR 5.7FR 58CM 407658","code_information":[{"code":"Px0000311400L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 7X5X120 VBH070502","code_information":[{"code":"Px0000311518L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11461.0,"discounted_cash":8022.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 8X5X120 VBH080502","code_information":[{"code":"Px0000311521L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11507.0,"discounted_cash":8054.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FLOW DIRECT PACING RT HEART 401763","code_information":[{"code":"Px0000311873L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SAFIRE BI MED CURL 4MM 402810","code_information":[{"code":"Px0000311881L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.17,"discounted_cash":1502.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABLTN BI-DIRECT 7FR 402811","code_information":[{"code":"Px0000311882L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.17,"discounted_cash":1502.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABLATION SAFIRE TX LC 7FR 402840","code_information":[{"code":"Px0000311883L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3109.77,"discounted_cash":2176.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE .035IN 180CM L 3MM J","code_information":[{"code":"Px0000311887L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY KYPHOPAK EXPESS ADD FX KPE1004","code_information":[{"code":"Px0000313455L","type":"CDM"}],"standard_charges":[{"gross_charge":5102.0,"discounted_cash":3571.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STARCLOSE SE VCS 1467901","code_information":[{"code":"Px0000313775L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.2,"discounted_cash":609.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INTRO VASC MICPUNC 5FR 10 G36333","code_information":[{"code":"Px0000313796L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH UNIFUSE 135 10CM INF 4FR H787124018215","code_information":[{"code":"Px0000313822L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":555.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHERE GRN QUADRA 50-100 V325QS","code_information":[{"code":"Px0000314055L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4674.0,"discounted_cash":3271.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC G WIRE FIELDER ASAHI 180 8235901","code_information":[{"code":"Px0000314120L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER IVC FEMORAL DELIV KIT EC500F","code_information":[{"code":"Px0000314366L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5543.0,"discounted_cash":3880.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X22X80 85443","code_information":[{"code":"Px0000314763L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FEM COMPRESSION WITH MANOMETER C11165","code_information":[{"code":"Px0000314807L","type":"CDM"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH STD CRV MED HTD 7FR 4MM M0045031THM0","code_information":[{"code":"Px0000314808L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2157.0,"discounted_cash":1509.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LG CRV MED HTD 7FR 4MM M0045031THMK20","code_information":[{"code":"Px0000314809L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2157.0,"discounted_cash":1509.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URO DIV OPN 7FR 80CM M0061602100","code_information":[{"code":"Px0000315396L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 6FR MPA2","code_information":[{"code":"Px0000315820L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BOOT MULTI-PODOUS REG 2 STRAP 7990550","code_information":[{"code":"Px0000316016L","type":"CDM"},{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.7,"discounted_cash":223.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SCORING 4.0 X 40 X 137 20764040","code_information":[{"code":"Px0000317438L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":2121.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SCORING 5.0 X 40 X 137 20765040","code_information":[{"code":"Px0000317439L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":2121.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE PILOT 50 .014 J EXP3 1010483HJ","code_information":[{"code":"Px0000317694L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE 014 WHISPER ES300 P3 1011835H","code_information":[{"code":"Px0000317700L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE .014 300CM MB12 AG14M370","code_information":[{"code":"Px0000317705L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTAV 23-4/9/100 Z-MED II 611765","code_information":[{"code":"Px0000318154L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2626.26,"discounted_cash":1838.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE DC LUNDERQUIST EXTRA STIF G45208","code_information":[{"code":"Px0000318733L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.2,"discounted_cash":517.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SUB GU FOR DEFIB 58CM 6996SQ58","code_information":[{"code":"Px0000320921L","type":"CDM"},{"code":"C1896","type":"HCPCS"}],"standard_charges":[{"gross_charge":6354.0,"discounted_cash":4447.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET AMPLATZ RENAL DILAL/SHEATH M0062602500","code_information":[{"code":"Px0000321140L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":659.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE SYNCRO .014 200CM M00313020","code_information":[{"code":"Px0000323134L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1787.0,"discounted_cash":1250.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BONE GRAFT INJECT 4CC PRODENSE","code_information":[{"code":"Px0000323535L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4628.0,"discounted_cash":3239.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EZ-STEER BI-DIRECT D-F BN7TCDF4L","code_information":[{"code":"Px0000324800L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":6445.0,"discounted_cash":4511.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X22 120CM 85453","code_information":[{"code":"Px0000326891L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6384.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE CORDIS 6FR JL3 67000000","code_information":[{"code":"Px0000327417L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLUDER AMPLATZER SEPTAL 15MM 9ASD015","code_information":[{"code":"Px0000327894L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":17791.0,"discounted_cash":12453.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SENSOR FLOTRAC W/84 IN TUBING","code_information":[{"code":"Px0000329203L","type":"CDM"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":912.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE FIELDER FC 180CM AGP140001 AGP140001","code_information":[{"code":"Px0000329247L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE ASHAI XT .014 190CM AGP140002","code_information":[{"code":"Px0000329248L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRAIN GP LOC PGTL 10F 20C","code_information":[{"code":"Px0000329277L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BILIARY REG RO MKR 8FX35C 27260","code_information":[{"code":"Px0000329553L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BILIARY REG RO MKR 10FX35 27261","code_information":[{"code":"Px0000329554L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRO SET 6FR 808600","code_information":[{"code":"Px0000329722L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SET CLARKE 2.5FR 21G G04528","code_information":[{"code":"Px0000329728L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SWARTZ 8.5FR LAMP 90D 407358","code_information":[{"code":"Px0000329984L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT INTRODUCER MICKEY G-18 98433","code_information":[{"code":"Px0000330024L","type":"CDM"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEALANT ARTISS PREFILLED 4ML 1501652SP","code_information":[{"code":"Px0000330080L","type":"CDM"},{"code":"C9250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.0,"discounted_cash":921.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACER DUAL CHAMBER S602/03","code_information":[{"code":"Px0000330178L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":20683.0,"discounted_cash":14478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE PROTECTN SPIDER FX 6MM","code_information":[{"code":"Px0000330203L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":5742.0,"discounted_cash":4019.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 7FR IBI XXL 81202","code_information":[{"code":"Px0000330308L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3162.0,"discounted_cash":2213.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT INTRODUCER MICKEY G-16","code_information":[{"code":"Px0000330348L","type":"CDM"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDG 5F.056 JL3.5LBT 100CM","code_information":[{"code":"Px0000330640L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDG 5F.056 JL4LBT 100CM","code_information":[{"code":"Px0000330641L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDG 5F.056 XB3.5LBT 100CM","code_information":[{"code":"Px0000330643L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDG 5F.056 JR 4 LBT 100CM","code_information":[{"code":"Px0000330644L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDG 5F.056 HSTCKLBT 100CM","code_information":[{"code":"Px0000330646L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RFA INTRO PROBE KIT M001262220","code_information":[{"code":"Px0000330648L","type":"CDM"}],"standard_charges":[{"gross_charge":5412.0,"discounted_cash":3788.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN APEX RX 4.0 X 12","code_information":[{"code":"Px0000330686L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN APEX RX 1.5 X 12 PUSH","code_information":[{"code":"Px0000330727L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN APEX RX 1.5 X 15 PUSH","code_information":[{"code":"Px0000330728L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRAN WINGSPAN 3.5X15MM","code_information":[{"code":"Px0000330733L","type":"CDM"}],"standard_charges":[{"gross_charge":14625.0,"discounted_cash":10237.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT WINGSPAN 4.5X15MM","code_information":[{"code":"Px0000330736L","type":"CDM"}],"standard_charges":[{"gross_charge":14625.0,"discounted_cash":10237.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 6CM 50055106","code_information":[{"code":"Px0000330805L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9646.0,"discounted_cash":6752.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 30CM 50055130","code_information":[{"code":"Px0000330806L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 40CM 50056140","code_information":[{"code":"Px0000330807L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9646.0,"discounted_cash":6752.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE ENDOWAVE 135CM 50CM TZ 50056150","code_information":[{"code":"Px0000330808L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MARKER GOLD FIDUCIAL 0.8MMX3MM","code_information":[{"code":"Px0000330907L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE WHOLEY STANDARD TIP","code_information":[{"code":"Px0000331115L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.12,"discounted_cash":199.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 40CM 50055140","code_information":[{"code":"Px0000331155L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD TEMPORARY PACEMAKER 401769","code_information":[{"code":"Px0000331169L","type":"CDM"}],"standard_charges":[{"gross_charge":369.6,"discounted_cash":258.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 4FR TEMPO 451443V2","code_information":[{"code":"Px0000331179L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.02,"discounted_cash":112.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV PORT SL 6.6FR TY 0606100","code_information":[{"code":"Px0000331185L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH MAHURKAR 11.5F 16CM","code_information":[{"code":"Px0000331188L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EXPO 5F SELECTIVE WRP H74908526512","code_information":[{"code":"Px0000331215L","type":"CDM"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN STERLING 4X2X135 RX","code_information":[{"code":"Px0000332264L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE .018/150 STRAIGHT","code_information":[{"code":"Px0000332269L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE EXCHANGE BENTSON M001491481","code_information":[{"code":"Px0000332270L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.41,"discounted_cash":133.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONE FILTER RECOVERY RC15","code_information":[{"code":"Px0000332894L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2815.0,"discounted_cash":1970.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CTRL CATH C-TIP FEM 7FR","code_information":[{"code":"Px0000333148L","type":"CDM"}],"standard_charges":[{"gross_charge":771.57,"discounted_cash":540.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 10X10 RSS003","code_information":[{"code":"Px0000333361L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.86,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACEMAKER BIVENT 8042","code_information":[{"code":"Px0000333697L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":31483.0,"discounted_cash":22038.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACEMAKER ADAPTA DR ADDRL1","code_information":[{"code":"Px0000333703L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":21357.0,"discounted_cash":14949.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 12CM 50055112","code_information":[{"code":"Px0000334204L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 18CM 50055118","code_information":[{"code":"Px0000334205L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 24CM 50055124","code_information":[{"code":"Px0000334206L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFU EKOSONIC MACH 4 50CM 50055150","code_information":[{"code":"Px0000334207L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ARCTIC SUN COOLING PAD UNIV 3170004","code_information":[{"code":"Px0000334293L","type":"CDM"}],"standard_charges":[{"gross_charge":1361.96,"discounted_cash":953.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PAD COOLING ARCTIC SUN SMALL 3170502","code_information":[{"code":"Px0000334294L","type":"CDM"}],"standard_charges":[{"gross_charge":4013.41,"discounted_cash":2809.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ARCTIC SUN COOLING PAD MED 3170702","code_information":[{"code":"Px0000334295L","type":"CDM"}],"standard_charges":[{"gross_charge":4013.41,"discounted_cash":2809.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ARTIC SUN COOLING PAD LG 3170902","code_information":[{"code":"Px0000334296L","type":"CDM"}],"standard_charges":[{"gross_charge":4013.41,"discounted_cash":2809.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HEMODIALYSIS ASPC18P-XL","code_information":[{"code":"Px0000334299L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1385.0,"discounted_cash":969.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HEMODIALYSIS SET 7FR 10CM","code_information":[{"code":"Px0000334301L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE 0.25 145CM","code_information":[{"code":"Px0000334420L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.95,"discounted_cash":70.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 8FR LG CURVE 8MM TIP M0044500THMK20","code_information":[{"code":"Px0000334508L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3701.0,"discounted_cash":2590.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 4FR DECA MED CURVE","code_information":[{"code":"Px0000334518L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":1313.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 10MMX20CM HELICAL 36-159 M001361590","code_information":[{"code":"Px0000334660L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 12MMX30CM HELICAL 36-162 M001361620","code_information":[{"code":"Px0000334661L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.0,"discounted_cash":1054.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 6MMX10CM HELICAL 36-156 M001361560","code_information":[{"code":"Px0000334665L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 8MMX20CM M001361580","code_information":[{"code":"Px0000334666L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT WINGSPAN 3.0X20MM M003WS0300200","code_information":[{"code":"Px0000334671L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":15649.0,"discounted_cash":10954.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT WINGSPAN 4.5 X 20MM","code_information":[{"code":"Px0000334672L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":14625.0,"discounted_cash":10237.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRAIN 12FRX30CM TOTAL H787140008055","code_information":[{"code":"Px0000334680L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 5FR LIVEWIRE","code_information":[{"code":"Px0000334690L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"discounted_cash":1029.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE .032 180CM 404560","code_information":[{"code":"Px0000334693L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE .032 260CM 404878","code_information":[{"code":"Px0000334694L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PIGTAIL 4FR 65CM MARKER 77572MP65","code_information":[{"code":"Px0000334761L","type":"CDM"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RESOLVE LKG DRAINAGE 10FR","code_information":[{"code":"Px0000334782L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BUTTON GASTRO 14FR 01201417","code_information":[{"code":"Px0000334795L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BUTTON GASTRO 20FR 01202025","code_information":[{"code":"Px0000334799L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED JEJU 0270-18-2.0-30 0270182030","code_information":[{"code":"Px0000334813L","type":"CDM"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED JEJU 0270182330","code_information":[{"code":"Px0000334814L","type":"CDM"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED JEJU MIC KEY 0270183045","code_information":[{"code":"Px0000334815L","type":"CDM"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 8FR PEEL AWAY 405129","code_information":[{"code":"Px0000334826L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIO GUN 18GX10 CM MU50120","code_information":[{"code":"Px0000334958L","type":"CDM"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE SET CHEST THAL-QUICK 10F","code_information":[{"code":"Px0000335034L","type":"CDM"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":736.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV COOK SFTY DL 4F 8C TY G43991","code_information":[{"code":"Px0000335069L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV COOK SFTY DL 4F 5C TY","code_information":[{"code":"Px0000335070L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY CV CATH TL 5F 8CM SAFETY","code_information":[{"code":"Px0000335071L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.2,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV SFTY TL 5FR 12CM TY","code_information":[{"code":"Px0000335073L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 4FR 7.5CM 504604S","code_information":[{"code":"Px0000335129L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 9FR .038 11CM 504609X","code_information":[{"code":"Px0000335132L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH AVANTI .035 10FR 11CM 504610X","code_information":[{"code":"Px0000335133L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.68,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 11FR .035 11CM 504611X","code_information":[{"code":"Px0000335134L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.68,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CSI AVANTIPLUS 5FR 504655X","code_information":[{"code":"Px0000335135L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.68,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CSI AVANTIPLUS 6FR 504656X","code_information":[{"code":"Px0000335136L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.68,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CSI AVANTIPLUS 7FR 504657X","code_information":[{"code":"Px0000335137L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.68,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CSI AVANTIPLUS 8FR 504658X","code_information":[{"code":"Px0000335138L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.68,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDING 67025690B","code_information":[{"code":"Px0000335141L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1595.97,"discounted_cash":1117.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE ENVOY XB ST 6F 90CM 67026090B","code_information":[{"code":"Px0000335142L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1595.97,"discounted_cash":1117.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TEMPO AQUA H1 SRD6107","code_information":[{"code":"Px0000335156L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING 8FR CORFLO 43IN","code_information":[{"code":"Px0000335161L","type":"CDM"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HICKMAN DL 7FR PED 0600570","code_information":[{"code":"Px0000335205L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC POLY PQC SL 3FR TY","code_information":[{"code":"Px0000335211L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":355.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 3FR SINGLE LUMEN 3163155","code_information":[{"code":"Px0000335212L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PER-Q POLY DL 4FR","code_information":[{"code":"Px0000335213L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PER-Q POLY DL 5FR","code_information":[{"code":"Px0000335214L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV MIDLINE SFTY SL 4FR","code_information":[{"code":"Px0000335216L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.61,"discounted_cash":342.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIALYSIS 10F DBL LUMEN","code_information":[{"code":"Px0000335300L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.71,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 5FR W/4CM NDL","code_information":[{"code":"Px0000335583L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BALL Z-MED II 15X3 611744","code_information":[{"code":"Px0000335591L","type":"CDM"}],"standard_charges":[{"gross_charge":2626.26,"discounted_cash":1838.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EXPO 5FR PIGTAIL","code_information":[{"code":"Px0000336007L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.58,"discounted_cash":43.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC DEST 6FR 45CM 5464501","code_information":[{"code":"Px0000336664L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER TRANS 8FR 60CM 406553","code_information":[{"code":"Px0000336665L","type":"CDM"}],"standard_charges":[{"gross_charge":371.08,"discounted_cash":259.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RENEGADE STC ST M001181370","code_information":[{"code":"Px0000336675L","type":"CDM"}],"standard_charges":[{"gross_charge":1484.0,"discounted_cash":1038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL INTLOK 12MMX20CM M001361610","code_information":[{"code":"Px0000336677L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WALLSTNT ESOPH PARTCVR23X28X12 M00516940","code_information":[{"code":"Px0000336809L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9780.0,"discounted_cash":6846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC POLY PQC SL 4FR TY","code_information":[{"code":"Px0000337620L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC POLY PQC SL 2F 30 TY","code_information":[{"code":"Px0000337622L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.38,"discounted_cash":296.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ATRIOSEPTOSTOMY 13.5MM","code_information":[{"code":"Px0000337642L","type":"CDM"}],"standard_charges":[{"gross_charge":1516.0,"discounted_cash":1061.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIALYSIS 8FR 12CM HEMOSIL SL12P","code_information":[{"code":"Px0000337802L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 14 FR 406136 406136","code_information":[{"code":"Px0000338026L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 12FR SHORT 406128 406128","code_information":[{"code":"Px0000338027L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BERENSTIEN 5F 10722102 H787107221025","code_information":[{"code":"Px0000338042L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HELICAL 2MMX20 M0013120221","code_information":[{"code":"Px0000338048L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HELICAL 4MMX40 312044","code_information":[{"code":"Px0000338049L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 11FR 65CM CL-71165","code_information":[{"code":"Px0000338053L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RESOLVE LKG DRAINAGE 12FR","code_information":[{"code":"Px0000338057L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 11CM CL07611","code_information":[{"code":"Px0000338060L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 9FR 24CM SUPERFLEX","code_information":[{"code":"Px0000338064L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.37,"discounted_cash":325.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT POWER ISP IMPL MRI W/8FR","code_information":[{"code":"Px0000338147L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.0,"discounted_cash":933.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROCATH EXCELSIOR SL-10 M0031681930","code_information":[{"code":"Px0000338168L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.0,"discounted_cash":1927.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH FLEXIMA TIGHT 27508","code_information":[{"code":"Px0000338192L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 5X20 GDC 18 2D 3525204","code_information":[{"code":"Px0000338250L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3396.0,"discounted_cash":2377.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 10MMX30CM HELICAL 36-160 M001361600","code_information":[{"code":"Px0000338263L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.0,"discounted_cash":1054.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 14MMX30CM HELICAL 36-164 M001361640","code_information":[{"code":"Px0000338266L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":985.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL GDC 18 2 D SHAPE 3527304","code_information":[{"code":"Px0000338286L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER 4FR 55CM RAABE","code_information":[{"code":"Px0000338303L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATHERIZATION 244589","code_information":[{"code":"Px0000338308L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":426.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH MULLINS 12FR 224687 G09171","code_information":[{"code":"Px0000338317L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE DEFLECT .035IN 145CM G07899","code_information":[{"code":"Px0000338320L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDE","code_information":[{"code":"Px0000338377L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN SIZING 25MMX3X80 PTS253","code_information":[{"code":"Px0000338464L","type":"CDM"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN SIZING 30MMX3X80","code_information":[{"code":"Px0000338465L","type":"CDM"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 8FR SL1 81CM SWARTZ 407400","code_information":[{"code":"Px0000338468L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":547.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOPROSTHESIS VIABIL BILIARY","code_information":[{"code":"Px0000338490L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11653.0,"discounted_cash":8157.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROBE FIAPC 2.3/6.9 20132-216","code_information":[{"code":"Px0000339757L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 5X120MMX120CM PRB3505120120","code_information":[{"code":"Px0000341645L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.32,"discounted_cash":1011.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X40MMX80CM PRB3507040080","code_information":[{"code":"Px0000342686L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X60MMX120CM PRB3507060120","code_information":[{"code":"Px0000342687L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X30MM X 120CM PRB3507030120","code_information":[{"code":"Px0000342998L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X30MM X 120CM PRB3508030120","code_information":[{"code":"Px0000342999L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X40MMX120CM PRB3508040120","code_information":[{"code":"Px0000343000L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.32,"discounted_cash":1011.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X60MMX120CM PRB3508060120","code_information":[{"code":"Px0000343001L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X80MMX120CM PRB3508080120","code_information":[{"code":"Px0000343002L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLATZER 12X9MM 9AVP2012","code_information":[{"code":"Px0000343007L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.53,"discounted_cash":2425.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLATZER 14X9MM 9AVP2014","code_information":[{"code":"Px0000343008L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2654.0,"discounted_cash":1857.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC POWER TRIALYSIS TEMP 20CM CURV 5613200","code_information":[{"code":"Px0000343406L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.01,"discounted_cash":614.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC POWER TRIALYSIS TEMP 30CM STRA","code_information":[{"code":"Px0000343407L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.1,"discounted_cash":576.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC POWER TRIALYSIS TEMP 15CM CURV 5613150","code_information":[{"code":"Px0000343418L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABLATION HALO 360 18MM 3204118","code_information":[{"code":"Px0000343468L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":5872.0,"discounted_cash":4110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EZ-STEER BI-DIRECT 8M F-J BN7TCFJ8L","code_information":[{"code":"Px0000344736L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":8462.78,"discounted_cash":5923.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BILIARY 16F 40CM G09205","code_information":[{"code":"Px0000345388L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X100MMX135CM AB35W05100135","code_information":[{"code":"Px0000348129L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH DESTINATION 8F 45CM 5484501","code_information":[{"code":"Px0000349409L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.68,"discounted_cash":391.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLASMABLADE WIDE SPAT TIP 4.0 PS200040","code_information":[{"code":"Px0000350649L","type":"CDM"}],"standard_charges":[{"gross_charge":1155.0,"discounted_cash":808.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV BI-CAVAL DL 19FR","code_information":[{"code":"Px0000353942L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":7900.0,"discounted_cash":5530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV BI-CAVAL DL 23FR","code_information":[{"code":"Px0000353944L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":7900.0,"discounted_cash":5530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYS EN SNARE 3.2FR CATH 2-4MM EN1003004","code_information":[{"code":"Px0000355553L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYS EN SNARE 3.2FR CATH 4-8MM EN1003008","code_information":[{"code":"Px0000355554L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYS EN SNARE 6FR CATH 9-15MM EN2006015","code_information":[{"code":"Px0000355556L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SNARE VASC EN 7FR CATH 18-30MM EN2007030","code_information":[{"code":"Px0000355558L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE NITREX .014 80CM N140801","code_information":[{"code":"Px0000355638L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":845.0,"discounted_cash":591.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELECTRODE CATH 6FR QUAD -REP 401430RH","code_information":[{"code":"Px0000356117L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP 6F QUAD SUP CRD-REP 401442RH","code_information":[{"code":"Px0000356118L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH QUAD 5F 120CM JSN -REP","code_information":[{"code":"Px0000356127L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP CRD2 6FX5MM -REP 402004RH","code_information":[{"code":"Px0000356138L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH VENTRICULAR II DRAIN SET 50318","code_information":[{"code":"Px0000356235L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SLCT 5F 130 H1 PNS5F130H1","code_information":[{"code":"Px0000356455L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SELECT 5F 130 SIM PNS5F130SIM","code_information":[{"code":"Px0000356456L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SELECT 5F 130 BER PNS5F130BER","code_information":[{"code":"Px0000356457L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 8FR 65CM","code_information":[{"code":"Px0000356873L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TRAILBLAZER .014 X 150CM","code_information":[{"code":"Px0000357187L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":604.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":604.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAMP 18MM CRV 8.5F 406965","code_information":[{"code":"Px0000357339L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.24,"discounted_cash":630.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH AGILIS CURL LG 8.5F G408324","code_information":[{"code":"Px0000357340L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3092.42,"discounted_cash":2164.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE EMBOSHIELD NAV6 315CM 2244031","code_information":[{"code":"Px0000357346L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.92,"discounted_cash":421.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ATLAS 7FR 20X40MMX120CM AT120204","code_information":[{"code":"Px0000357581L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ATLAS 20X4 75CM AT75204","code_information":[{"code":"Px0000357582L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ATLAS 24X4 75CM","code_information":[{"code":"Px0000357586L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEPHROURETERO 8.5FR 28CM G48183","code_information":[{"code":"Px0000357617L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAIN EXT VENTR DUET-SMARTST 46914","code_information":[{"code":"Px0000357752L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH JETSTREAM G3 2.1 3.0 112264001","code_information":[{"code":"Px0000357876L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":9180.0,"discounted_cash":6426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT ANCHR MIC SAF-T-PEXY FSTNR 98701","code_information":[{"code":"Px0000357957L","type":"CDM"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ATTAIN LV 419688","code_information":[{"code":"Px0000358163L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIAG ACUNAV 8F 90CM 10135936","code_information":[{"code":"Px0000358190L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":8014.0,"discounted_cash":5609.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY CATH TRIALYSIS CRV 15CM 5615150","code_information":[{"code":"Px0000358201L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.37,"discounted_cash":675.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY CATH TRIALYSIS CRV 20CM","code_information":[{"code":"Px0000358202L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.37,"discounted_cash":675.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 8FR 90CM FJ CRV","code_information":[{"code":"Px0000358245L","type":"CDM"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":1282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1432.0,"discounted_cash":1002.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GUIDELINER 8F 20/135CM 5573","code_information":[{"code":"Px0000358352L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1432.0,"discounted_cash":1002.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LASSO 2515 VARIABLE -REP","code_information":[{"code":"Px0000359144L","type":"CDM"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.0,"discounted_cash":1383.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT POWER VACCESS 8F","code_information":[{"code":"Px0000359223L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":730.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT INTRO MICKEY G-14 98431","code_information":[{"code":"Px0000359294L","type":"CDM"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION .035 2CM 3MM G42406","code_information":[{"code":"Px0000359425L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION .035 3CM 5MM","code_information":[{"code":"Px0000359426L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 14FR 038 30CM G08957","code_information":[{"code":"Px0000359795L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":363.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RENEGADE STC 18 150/30","code_information":[{"code":"Px0000360076L","type":"CDM"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PATCH EXTERNAL REF CARTO3 CREFP6","code_information":[{"code":"Px0000360347L","type":"CDM"}],"standard_charges":[{"gross_charge":1798.18,"discounted_cash":1258.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY CATH TRIALYSIS ST 20CM 5605200","code_information":[{"code":"Px0000360358L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.25,"discounted_cash":642.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RADIAL TIG 5F 1.7X100 405011","code_information":[{"code":"Px0000360568L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RADIAL JACKY 5F 1.7X100 405021","code_information":[{"code":"Px0000360569L","type":"CDM"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE RUNTHRU .014X180X3 251011","code_information":[{"code":"Px0000360570L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABLA NAV EZ 4MM F/J CRV BN7TCFJ4L","code_information":[{"code":"Px0000360844L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":7283.87,"discounted_cash":5098.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIAG ACUNAV 8F 90CM -REP 10135936RH","code_information":[{"code":"Px0000361283L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":2768.0,"discounted_cash":1937.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.0 X 8 H7493912408200","code_information":[{"code":"Px0000361834L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":332.64,"discounted_cash":232.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.0 X 12 H7493912412200","code_information":[{"code":"Px0000361845L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.64,"discounted_cash":232.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.75 X 15 H7493912415270","code_information":[{"code":"Px0000361859L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.25 X 15 H7493912415320","code_information":[{"code":"Px0000361861L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.75 X 15 H7493912415370","code_information":[{"code":"Px0000361863L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.0 X 15 H7493912415400","code_information":[{"code":"Px0000361864L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FCP ENDO BCKLDNG BIOP 115CM G48240","code_information":[{"code":"Px0000362529L","type":"CDM"}],"standard_charges":[{"gross_charge":1407.27,"discounted_cash":985.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE VIPER ADV.014-.017 VPRGW17","code_information":[{"code":"Px0000362558L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC DEST 6FR 90CM STR RSC05","code_information":[{"code":"Px0000362764L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.12,"discounted_cash":476.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 10F .038 30CM","code_information":[{"code":"Px0000362825L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DAC 044 130CM","code_information":[{"code":"Px0000363271L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3144.0,"discounted_cash":2200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER OPTION IVC 30MM 352506070","code_information":[{"code":"Px0000363609L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":3243.0,"discounted_cash":2270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE 3MM J 038 X 150","code_information":[{"code":"Px0000363653L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.44,"discounted_cash":66.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOCROSS 2.5X210MMX150CM AB14W025210150","code_information":[{"code":"Px0000364288L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X210MMX150CM AB14W030210150","code_information":[{"code":"Px0000364289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOCROSS 3.5X210MMX150CM AB14W035210150","code_information":[{"code":"Px0000364290L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X210MMX150CM AB14W040210150","code_information":[{"code":"Px0000364291L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X150MMX150CM AB14W020150150","code_information":[{"code":"Px0000364292L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOCROSS 2.5X150MMX150CM AB14W025150150","code_information":[{"code":"Px0000364293L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOCROSS 3.0X150MMX150CM AB14W030150150","code_information":[{"code":"Px0000364294L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOCROSS 4.0X150MMX150CM AB14W040150150","code_information":[{"code":"Px0000364296L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE FATHOM .014 200CM M001508100","code_information":[{"code":"Px0000364351L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SWAN GANZ 6FR 110CM  096F6P","code_information":[{"code":"Px0000364438L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR 20X9MM 9AVP2020","code_information":[{"code":"Px0000364513L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2654.0,"discounted_cash":1857.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR 22X9MM 9AVP2022","code_information":[{"code":"Px0000364514L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2782.0,"discounted_cash":1947.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X60MMX80CM PRB3507060080","code_information":[{"code":"Px0000365165L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI EVRFLX 8X80MMX80CM PRB3508080080","code_information":[{"code":"Px0000365167L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.32,"discounted_cash":1011.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PROTEGE 12X80MMX80CM SERB65128080","code_information":[{"code":"Px0000365169L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEEDING MIC-KEY 14FR 3.5 01201435","code_information":[{"code":"Px0000365171L","type":"CDM"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRAN NEUROFRM3 EZ 3X20MM","code_information":[{"code":"Px0000365218L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":21369.0,"discounted_cash":14958.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN FEMORAL ART 12FR","code_information":[{"code":"Px0000365403L","type":"CDM"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":800.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE HT WINN 200T 300CM 1012475","code_information":[{"code":"Px0000365431L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 4.0X3X135","code_information":[{"code":"Px0000365455L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X40MMX135CM AB35W04040135","code_information":[{"code":"Px0000365456L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X60MMX135CM AB35W04060135","code_information":[{"code":"Px0000365457L","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: WSH 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":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X150MMX135CM AB35W05150135","code_information":[{"code":"Px0000365459L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X200MMX135CM AB35W05200135","code_information":[{"code":"Px0000365460L","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: WSH 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":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X40MMX135CM AB35W06040135","code_information":[{"code":"Px0000365462L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X60MMX135CM AB35W06060135","code_information":[{"code":"Px0000365463L","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: WSH 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":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X100MMX135CM AB35W06100135","code_information":[{"code":"Px0000365465L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X200MMX135CM AB35W06200135","code_information":[{"code":"Px0000365466L","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: WSH 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":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X40MMX135CM AB35W07040135","code_information":[{"code":"Px0000365468L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X80MMX135CM AB35W07080135","code_information":[{"code":"Px0000365470L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X200MMX135CM AB35W07200135","code_information":[{"code":"Px0000365472L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 8X20MMX135CM AB35W08020135","code_information":[{"code":"Px0000365473L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 8X30MMX135CM AB35W08030135","code_information":[{"code":"Px0000365474L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 8X40MMX135CM AB35W08040135","code_information":[{"code":"Px0000365475L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 8X60MMX135CM AB35W08060135","code_information":[{"code":"Px0000365476L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 8X80MMX135CM AB35W08080135","code_information":[{"code":"Px0000365477L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 5.0X3X80","code_information":[{"code":"Px0000365478L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X40MMX80CM AB35W05040080","code_information":[{"code":"Px0000365479L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X60MMX80CM AB35W05060080","code_information":[{"code":"Px0000365480L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X80MMX80CM AB35W05080080","code_information":[{"code":"Px0000365481L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 5.0X10X80 AB35W05100080","code_information":[{"code":"Px0000365482L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X150MMX80CM AB35W05150080","code_information":[{"code":"Px0000365483L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X20MMX80CM AB35W06020080","code_information":[{"code":"Px0000365484L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 6.0X3X80","code_information":[{"code":"Px0000365485L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X40MMX80CM AB35W06040080","code_information":[{"code":"Px0000365486L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 7.0X2X80","code_information":[{"code":"Px0000365487L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X30MMX80CM","code_information":[{"code":"Px0000365488L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X40MMX80CM AB35W07040080","code_information":[{"code":"Px0000365489L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X60MMX80CM AB35W07060080","code_information":[{"code":"Px0000365490L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X80MMX80CM AB35W07080080","code_information":[{"code":"Px0000365491L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 7.0X10X80 AB35W07100080","code_information":[{"code":"Px0000365492L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 7.0X150X80 AB35W07150080","code_information":[{"code":"Px0000365493L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X200MMX80CM AB35W07200080","code_information":[{"code":"Px0000365494L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 8.0X2X80 AB35W08020080","code_information":[{"code":"Px0000365495L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 8X30MMX80CM","code_information":[{"code":"Px0000365496L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 8X40MMX80CM AB35W08040080","code_information":[{"code":"Px0000365497L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 8.0X6X80 AB35W08060080","code_information":[{"code":"Px0000365500L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 8.0X8X80 AB35W08080080","code_information":[{"code":"Px0000365501L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 9.0X2X80 AB35W09020080","code_information":[{"code":"Px0000365502L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 9.0X4X80 AB35W09040080","code_information":[{"code":"Px0000365504L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 9X60MMX80CM AB35W09060080","code_information":[{"code":"Px0000365505L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 9X80MMX80CM","code_information":[{"code":"Px0000365506L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 10X30MMX80CM","code_information":[{"code":"Px0000365507L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 10X40MMX80CM AB35W10040080","code_information":[{"code":"Px0000365508L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 10.0X6X80 AB35W10060080","code_information":[{"code":"Px0000365509L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 12X40MMX80CM AB35W12040080","code_information":[{"code":"Px0000365510L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 12.0X6X80 AB35W12060080","code_information":[{"code":"Px0000365511L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 5.0X4X40","code_information":[{"code":"Px0000365512L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X40MMX40CM AB35W07040040","code_information":[{"code":"Px0000365513L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEART TRAIL 3 6FR TIGMOD 4.0 406311","code_information":[{"code":"Px0000366150L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 9 X 27MM X 80CM PXB350927080","code_information":[{"code":"Px0000366296L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 9 X 57MM X 80CM PXB35-09-57-080 PXB350957080","code_information":[{"code":"Px0000366297L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 10X27MMX80CM PXB351027080","code_information":[{"code":"Px0000366298L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 10X37MMX80CM PXB351037080","code_information":[{"code":"Px0000366299L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VISI-PRO 10X57MMX80CM PXB351057080","code_information":[{"code":"Px0000366300L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAINAGE SET FUHRMAN PLEURAL G55723","code_information":[{"code":"Px0000367013L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.58,"discounted_cash":463.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 8FR 65CM DESTINATION 5486501","code_information":[{"code":"Px0000367178L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.4,"discounted_cash":434.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE ASAHI FLDR FC 300CM AGP140301","code_information":[{"code":"Px0000367185L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 5FR RADIAL","code_information":[{"code":"Px0000367186L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRSG INCIS PREVENA UP-TO-8IN PRE1055US","code_information":[{"code":"Px0000368143L","type":"CDM"}],"standard_charges":[{"gross_charge":1149.51,"discounted_cash":804.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMARTVEST WRAP SGL MED","code_information":[{"code":"Px0000368169L","type":"CDM"}],"standard_charges":[{"gross_charge":274.56,"discounted_cash":192.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMARTVEST WRAP SGL X LARGE","code_information":[{"code":"Px0000368170L","type":"CDM"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMARTVEST WRAP SGL XX LARGE","code_information":[{"code":"Px0000368171L","type":"CDM"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 6FR INQ STEERABLE QUAD","code_information":[{"code":"Px0000368316L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.13,"discounted_cash":914.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VEST PULM SMARTVEST CLR SM","code_information":[{"code":"Px0000369130L","type":"CDM"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMARTVEST WRAP SGL LARGE","code_information":[{"code":"Px0000369131L","type":"CDM"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE HYDRO STD ANG 35/150","code_information":[{"code":"Px0000369332L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LUMA STEER 1102-L-7-5-L","code_information":[{"code":"Px0000369447L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2237.0,"discounted_cash":1565.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE SAFESEPT 135CM SS135","code_information":[{"code":"Px0000369496L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.0,"discounted_cash":519.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X08MM 101227208","code_information":[{"code":"Px0000369641L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X12MM 101227212","code_information":[{"code":"Px0000369642L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X15MM 101227215","code_information":[{"code":"Px0000369643L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X20MM 101227220","code_information":[{"code":"Px0000369644L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X25MM 101227225","code_information":[{"code":"Px0000369645L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 3.0X12MM 101227412","code_information":[{"code":"Px0000369656L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 3.0X15MM 101227415","code_information":[{"code":"Px0000369657L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 3.0X20MM 101227420","code_information":[{"code":"Px0000369658L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 3.0X25MM 101227425","code_information":[{"code":"Px0000369659L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 3.50X12MM 101227612","code_information":[{"code":"Px0000369670L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 3.50X15MM 101227615","code_information":[{"code":"Px0000369671L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 4.0X08MM 101227808","code_information":[{"code":"Px0000369683L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 4.0X15MM 101227815","code_information":[{"code":"Px0000369685L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 4.0X20MM 101227820","code_information":[{"code":"Px0000369686L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TREK RX 5.0X15MM 101228015","code_information":[{"code":"Px0000369692L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 1.5X80X150 A2015080","code_information":[{"code":"Px0000369829L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 1.5X120X150 A2015120","code_information":[{"code":"Px0000369830L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X20X150 A2020020","code_information":[{"code":"Px0000369831L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X40X150 A2020040","code_information":[{"code":"Px0000369832L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X60X150 A2020060","code_information":[{"code":"Px0000369833L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X80X150 A2020080","code_information":[{"code":"Px0000369834L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X120X150 A2020120","code_information":[{"code":"Px0000369835L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X200X150 A2020200","code_information":[{"code":"Px0000369836L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.5X20X150 A2025020","code_information":[{"code":"Px0000369837L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.5X40X150 A2025040","code_information":[{"code":"Px0000369838L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.5X60X150 A2025060","code_information":[{"code":"Px0000369839L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.5X80X150 A2025080","code_information":[{"code":"Px0000369840L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X20X150 A2030020","code_information":[{"code":"Px0000369841L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X40X150 A2030040","code_information":[{"code":"Px0000369842L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X60X150 A2030060","code_information":[{"code":"Px0000369843L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X80X150 A2030080","code_information":[{"code":"Px0000369844L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X120X150 A2030120","code_information":[{"code":"Px0000369845L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X200X150 A2030200","code_information":[{"code":"Px0000369846L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X20X150 A2040020","code_information":[{"code":"Px0000369847L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X40X150 A2040040","code_information":[{"code":"Px0000369848L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X80X150 A2040080","code_information":[{"code":"Px0000369849L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X120X150 A2040120","code_information":[{"code":"Px0000369850L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X200X150 A2040200","code_information":[{"code":"Px0000369851L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X06MM 101226906","code_information":[{"code":"Px0000370225L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X08MM 101226908","code_information":[{"code":"Px0000370226L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X12MM 101226912","code_information":[{"code":"Px0000370227L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X15MM 101226915","code_information":[{"code":"Px0000370228L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X08MM 101227008","code_information":[{"code":"Px0000370231L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X12MM 101227012","code_information":[{"code":"Px0000370232L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X15MM 101227015","code_information":[{"code":"Px0000370233L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X20MM 101227020","code_information":[{"code":"Px0000370234L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X25MM 101227025","code_information":[{"code":"Px0000370235L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT ELECTRODE NAVX VELOCITY","code_information":[{"code":"Px0000370326L","type":"CDM"}],"standard_charges":[{"gross_charge":3522.0,"discounted_cash":2465.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X210MMX150CM AB14W020210150","code_information":[{"code":"Px0000370695L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER SWARTZ SL1 81CM","code_information":[{"code":"Px0000371515L","type":"CDM"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":690.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CURETTE SIZE 2 T-TIP A13A","code_information":[{"code":"Px0000372218L","type":"CDM"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 712265","code_information":[{"code":"Px0000372383L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ICD DURATA LENGTH 60 712260","code_information":[{"code":"Px0000372385L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6475.95,"discounted_cash":4533.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BATTERY HRTMET 14V LI-ON SET","code_information":[{"code":"Px0000372405L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":2300.0,"discounted_cash":1610.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CLIP BATT HRTME LI-ON 14V SET","code_information":[{"code":"Px0000372406L","type":"CDM"},{"code":"Q0497","type":"HCPCS"}],"standard_charges":[{"gross_charge":2056.0,"discounted_cash":1439.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHARGER HRTMTE BATT UNIV","code_information":[{"code":"Px0000372411L","type":"CDM"},{"code":"Q0495","type":"HCPCS"}],"standard_charges":[{"gross_charge":20506.0,"discounted_cash":14354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 7FR 11CM","code_information":[{"code":"Px0000372427L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.18,"discounted_cash":236.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X40MMX80CM AB35W04040080","code_information":[{"code":"Px0000372440L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BRIDLE NASAL 10FR TEAL 44110","code_information":[{"code":"Px0000372974L","type":"CDM"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSXC","code_information":[{"code":"Px0000372995L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9646.0,"discounted_cash":6752.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSSC","code_information":[{"code":"Px0000372996L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9646.0,"discounted_cash":6752.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X60X150 A2040060","code_information":[{"code":"Px0000373040L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ANGIOJET SOLENT 6FR 90CM 109676001","code_information":[{"code":"Px0000373166L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3057.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 2.0X12MM 101244512","code_information":[{"code":"Px0000373169L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 2.0X20MM 101244520","code_information":[{"code":"Px0000373171L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 2.25X15MM 101244615","code_information":[{"code":"Px0000373174L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 2.5X12MM 101244712","code_information":[{"code":"Px0000373177L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 2.5X25MM 101244725","code_information":[{"code":"Px0000373180L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.0X8MM 101244908","code_information":[{"code":"Px0000373185L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.0X20MM 101244920","code_information":[{"code":"Px0000373188L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.0X25MM 101244925","code_information":[{"code":"Px0000373189L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.25X12MM 101245012","code_information":[{"code":"Px0000373190L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X8MM 101245108","code_information":[{"code":"Px0000373192L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X12MM 101245112","code_information":[{"code":"Px0000373193L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X15MM 101245115","code_information":[{"code":"Px0000373194L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X20MM 101245120","code_information":[{"code":"Px0000373195L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.75X15MM 101245215","code_information":[{"code":"Px0000373198L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X8MM 101245308","code_information":[{"code":"Px0000373200L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X12MM 101245312","code_information":[{"code":"Px0000373201L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X15MM 101245315","code_information":[{"code":"Px0000373202L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 4.5X12MM 101245412","code_information":[{"code":"Px0000373203L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 5.0X12MM 101245512","code_information":[{"code":"Px0000373204L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 5.0X20MM 101245520","code_information":[{"code":"Px0000373205L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 1.5X6MM 101244406","code_information":[{"code":"Px0000373267L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 1.5X8MM 101244408","code_information":[{"code":"Px0000373268L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.0X6MM 101244906","code_information":[{"code":"Px0000373276L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.25X20MM 101245020","code_information":[{"code":"Px0000373279L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X25MM 101245125","code_information":[{"code":"Px0000373281L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X20MM 101245320","code_information":[{"code":"Px0000373282L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC TREK 5.0X15MM 101245515","code_information":[{"code":"Px0000373287L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 STD 7MMX20CM M0035467200","code_information":[{"code":"Px0000373392L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4487.0,"discounted_cash":3140.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 2MMX4CM M0035472040 M0035472040","code_information":[{"code":"Px0000373402L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 3MMX6CM M0035473060 M0035473060","code_information":[{"code":"Px0000373403L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 3MMX8CM M0035473080 M0035473080","code_information":[{"code":"Px0000373404L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 4MMX8CM M0035474080","code_information":[{"code":"Px0000373406L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 4MMX10CM M0035474100","code_information":[{"code":"Px0000373407L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 5MMX10CM M0035475100","code_information":[{"code":"Px0000373408L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 5MMX15CM M0035475150","code_information":[{"code":"Px0000373409L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 6MMX10CM M0035476100","code_information":[{"code":"Px0000373410L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 6MMX15CM M0035476150","code_information":[{"code":"Px0000373411L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 7MMX15CM M0035477150","code_information":[{"code":"Px0000373412L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 7MMX20CM M0035477200","code_information":[{"code":"Px0000373413L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4043.87,"discounted_cash":2830.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 8MMX20CM M0035478200","code_information":[{"code":"Px0000373414L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 9MMX20CM M0035479200","code_information":[{"code":"Px0000373415L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 9MMX30CM M0035479300","code_information":[{"code":"Px0000373416L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 10MMX30CM M0035471030","code_information":[{"code":"Px0000373417L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":3346.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 2MMX3CM M0035422030","code_information":[{"code":"Px0000373422L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 2MMX4CM M0035422040","code_information":[{"code":"Px0000373423L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 2.5MMX4CM M0035422540","code_information":[{"code":"Px0000373424L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 3MMX4CM M0035423040","code_information":[{"code":"Px0000373425L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 3MMX6CM M0035423060","code_information":[{"code":"Px0000373426L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 3MMX8CM M0035423080","code_information":[{"code":"Px0000373427L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 4MMX6CM M0035424060","code_information":[{"code":"Px0000373428L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 4MMX8CM M0035424080","code_information":[{"code":"Px0000373429L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 4MMX10CM M0035424100","code_information":[{"code":"Px0000373430L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 5MMX10CM M0035425100","code_information":[{"code":"Px0000373431L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 4MMX20MMX75CM H74939171040270","code_information":[{"code":"Px0000373475L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 4X40MMX75CM H74939171040470","code_information":[{"code":"Px0000373477L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 5MMX20MMX75CM H74939171050270","code_information":[{"code":"Px0000373485L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 5MMX40MMX75CM H74939171050470","code_information":[{"code":"Px0000373487L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 6MMX20MMX75CM H74939171060270","code_information":[{"code":"Px0000373495L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 6MMX30MMX75CM H74939171060370","code_information":[{"code":"Px0000373496L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 6X40MMX75CM H74939171060470","code_information":[{"code":"Px0000373497L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX20MMX75CM H74939171070270","code_information":[{"code":"Px0000373505L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX30MMX75CM H74939171070370","code_information":[{"code":"Px0000373506L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 7X40MMX75CM H74939171070470","code_information":[{"code":"Px0000373507L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 8MMX20MMX75CM H74939171080270","code_information":[{"code":"Px0000373515L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 8MMX30MMX75CM H74939171080370","code_information":[{"code":"Px0000373516L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 8X40MMX75CM H74939171080470","code_information":[{"code":"Px0000373517L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 9MMX20MMX75CM H74939171090270","code_information":[{"code":"Px0000373525L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 9MMX30MMX75CM H74939171090370","code_information":[{"code":"Px0000373526L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 9MMX40MMX75CM H74939171090470","code_information":[{"code":"Px0000373527L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 10X20MMX75CM H74939171100270","code_information":[{"code":"Px0000373530L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 10X40MMX75CM H74939171100470","code_information":[{"code":"Px0000373532L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 10X60MMX75CM H74939171100670","code_information":[{"code":"Px0000373533L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 12MMX20MMX75CM H74939171120270","code_information":[{"code":"Px0000373535L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 12X40MMX75CM H74939171120470","code_information":[{"code":"Px0000373537L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 3MMX20MMX135CM H74939171030210","code_information":[{"code":"Px0000373540L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 4MMX20MMX135CM H74939171040210","code_information":[{"code":"Px0000373550L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 4MMX40MMX135CM H74939171040410","code_information":[{"code":"Px0000373552L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 4MMX200MMX135CM H74939171042010","code_information":[{"code":"Px0000373559L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 5X20MMX135CM H74939171050210","code_information":[{"code":"Px0000373560L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 5MMX40MMX135CM H74939171050410","code_information":[{"code":"Px0000373562L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 6MMX20MMX135CM H74939171060210","code_information":[{"code":"Px0000373570L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 6X40MMX135CM H74939171060410","code_information":[{"code":"Px0000373572L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 6X60MMX135CM H74939171060610","code_information":[{"code":"Px0000373573L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 6MMX200MMX135CM H74939171062010","code_information":[{"code":"Px0000373579L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX20MMX135CM H74939171070210","code_information":[{"code":"Px0000373580L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX40MMX135CM H74939171070410","code_information":[{"code":"Px0000373582L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX60MMX135CM H74939171070610","code_information":[{"code":"Px0000373583L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX100MMX135CM H74939171071010","code_information":[{"code":"Px0000373585L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 8MMX20MMX135CM H74939171080210","code_information":[{"code":"Px0000373590L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 8X40MMX135CM H74939171080410","code_information":[{"code":"Px0000373592L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 9MMX20MMX135CM H74939171090210","code_information":[{"code":"Px0000373600L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 9MMX40MMX135CM H74939171090410","code_information":[{"code":"Px0000373602L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 10MMX40MMX135CM H74939171100410","code_information":[{"code":"Px0000373607L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX40MMX40CM","code_information":[{"code":"Px0000373622L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACK TUBING ECMO PEDS CUSTOM","code_information":[{"code":"Px0000373926L","type":"CDM"}],"standard_charges":[{"gross_charge":6304.0,"discounted_cash":4412.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACK TUBING ECMO ADULT CUSTOM","code_information":[{"code":"Px0000373927L","type":"CDM"}],"standard_charges":[{"gross_charge":5146.0,"discounted_cash":3602.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .014 2.50X120MMX150C A2025120","code_information":[{"code":"Px0000373962L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .014 2.50X200MMX150C A2025200","code_information":[{"code":"Px0000373963L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT RX CNTR BEND 10FR 7CM M00534690","code_information":[{"code":"Px0000373971L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EXTRACT RETRV 12-15 M00547010","code_information":[{"code":"Px0000373973L","type":"CDM"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MUSTANG 7MMX80MMX75CM","code_information":[{"code":"Px0000373978L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 10X80MMX75CM","code_information":[{"code":"Px0000373980L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CEMENT AND MIXER KYPHON XPEDE CX01B","code_information":[{"code":"Px0000374036L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CHAIT TRAPDOR CECOSTOMY","code_information":[{"code":"Px0000374209L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X80MMX150CM AB14W020080150","code_information":[{"code":"Px0000374269L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN SIZING 20MMX3","code_information":[{"code":"Px0000374389L","type":"CDM"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CABLE HRTMTE PAT 14V","code_information":[{"code":"Px0000374514L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR TCS DL 5FR FULL 1275108","code_information":[{"code":"Px0000375324L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.21,"discounted_cash":716.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR TCS SL 4FR FULL","code_information":[{"code":"Px0000375326L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":691.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR TCS SL 5FR FULL","code_information":[{"code":"Px0000375327L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":691.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ACHIEVE MAPPING 20CM 990063020","code_information":[{"code":"Px0000375565L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2731.0,"discounted_cash":1911.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAILBLAZER CATH .018X135CM SC018135","code_information":[{"code":"Px0000375619L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.5,"discounted_cash":422.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OXYGENATOR PED QUADROX-ID 701050330","code_information":[{"code":"Px0000375627L","type":"CDM"}],"standard_charges":[{"gross_charge":6844.0,"discounted_cash":4790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INFUSION PROWLER PRESHAPE 606171","code_information":[{"code":"Px0000375719L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2623.0,"discounted_cash":1836.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD PUMP CENTRIMAG DISP 20190015","code_information":[{"code":"Px0000375741L","type":"CDM"}],"standard_charges":[{"gross_charge":24668.0,"discounted_cash":17267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD PUMP PEDIMAG DISP","code_information":[{"code":"Px0000375742L","type":"CDM"}],"standard_charges":[{"gross_charge":17160.0,"discounted_cash":12012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OXYGENATOR ADULT QUADROX-ID","code_information":[{"code":"Px0000375907L","type":"CDM"}],"standard_charges":[{"gross_charge":4794.0,"discounted_cash":3355.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH 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: WSH 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: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH FLEXOR KCFW 12F 80CM G49487","code_information":[{"code":"Px0000376034L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL BIOP ONCNTRL STY TY 102MM 9408VC006","code_information":[{"code":"Px0000376100L","type":"CDM"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY BIOPSY ONCONTROL 152MM 9411VC006","code_information":[{"code":"Px0000376101L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET THRMB SOLENT OMNI 109681001","code_information":[{"code":"Px0000376223L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":3714.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EXPO 5FR 125SM MPA2","code_information":[{"code":"Px0000376233L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEART ARTIFICIAL TAH-TKT 70CC","code_information":[{"code":"Px0000377615L","type":"CDM"}],"standard_charges":[{"gross_charge":340000.0,"discounted_cash":238000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 2D .35 8X40 M001363590","code_information":[{"code":"Px0000377671L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2612.0,"discounted_cash":1828.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEST TUBE THAL QUIK 10FR","code_information":[{"code":"Px0000377826L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1015.87,"discounted_cash":711.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEST TUBE THAL QUIK 14FR G07090","code_information":[{"code":"Px0000377827L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":595.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VIPER SLIDE VPR-SLD2 VPRSLD2","code_information":[{"code":"Px0000377863L","type":"CDM"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROINTRODUCER KIT 4FR","code_information":[{"code":"Px0000377957L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRO 7F 4CM MARKER TIP PSS7F4MT","code_information":[{"code":"Px0000377958L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON MAX 6F 90X4CM PNML6F088904","code_information":[{"code":"Px0000378292L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SELECT 6F 125SIM PNS6F125SIM","code_information":[{"code":"Px0000378293L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SELECT 6F 125BER PNS6F125BER","code_information":[{"code":"Px0000378294L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE TFLN STR .035 80CM G04003","code_information":[{"code":"Px0000378430L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH DESTINATION 7F 90CM RSC06","code_information":[{"code":"Px0000378479L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.12,"discounted_cash":476.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4.0X150MMX135CM B2040150","code_information":[{"code":"Px0000378677L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4.0X250MMX135CM B2040250","code_information":[{"code":"Px0000378679L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5.0X150MMX135CM B2050150","code_information":[{"code":"Px0000378680L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5.0X200MMX135CM B2050200","code_information":[{"code":"Px0000378681L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5.0X250MMX135CM B2050250","code_information":[{"code":"Px0000378682L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6.0X150MMX135CM B2060150","code_information":[{"code":"Px0000378683L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6.0X250MMX135CM B2060250","code_information":[{"code":"Px0000378685L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7.0X150MMX135CM B2070150","code_information":[{"code":"Px0000378686L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG J 180CM GR3525","code_information":[{"code":"Px0000378782L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X120MMX135CM AB35W05120135","code_information":[{"code":"Px0000378962L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 3.5X40MMX150CM AB14W035040150","code_information":[{"code":"Px0000379063L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ACTY CA CS-IC 130 6FR 69C 7042","code_information":[{"code":"Px0000379229L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.0,"discounted_cash":662.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE CLEANER THRMBCTMY 65CM 700009XT","code_information":[{"code":"Px0000379276L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2158.63,"discounted_cash":1511.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP CRYO 5CRV LNG","code_information":[{"code":"Px0000380827L","type":"CDM"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 ULTRA 3MMX10CM M0035423100","code_information":[{"code":"Px0000381357L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 ULTRA 4MMX15CM M0035424150","code_information":[{"code":"Px0000381358L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 ULTRA 5MMX15CM M0035425150","code_information":[{"code":"Px0000381359L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH HEL ULTRA 2MMX8CM M0035432080","code_information":[{"code":"Px0000381360L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3342.0,"discounted_cash":2339.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH HEL ULTRA 3MMX10CM M0035433100","code_information":[{"code":"Px0000381361L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3342.0,"discounted_cash":2339.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 STD 6MMX30CM M0035466300","code_information":[{"code":"Px0000381367L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4487.0,"discounted_cash":3140.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 SOFT 4MMX15CM M0035474150","code_information":[{"code":"Px0000381371L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4043.87,"discounted_cash":2830.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 SOFT 5MMX20CM M0035475200","code_information":[{"code":"Px0000381372L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4043.87,"discounted_cash":2830.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 SOFT 8MMX30CM M0035478300","code_information":[{"code":"Px0000381375L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4043.87,"discounted_cash":2830.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 6MMX20CM M0035476200","code_information":[{"code":"Px0000382564L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4043.87,"discounted_cash":2830.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 2MMX6CM M0035422060","code_information":[{"code":"Px0000382568L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SUPREME DECAPOLAR 5 FR","code_information":[{"code":"Px0000382819L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1579.0,"discounted_cash":1105.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD RELIANCE DF4 AF DC 64CM 0276","code_information":[{"code":"Px0000383889L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":4509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK CUBE .35 10X40","code_information":[{"code":"Px0000383957L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2612.0,"discounted_cash":1828.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 2D .35 12X40 M001363630","code_information":[{"code":"Px0000383958L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2612.0,"discounted_cash":1828.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 5X17MMX135CM PXB350517135","code_information":[{"code":"Px0000384067L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 6X17MMX135CM PXB350617135","code_information":[{"code":"Px0000384071L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3640.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 7X17MMX135CM PXB350717135","code_information":[{"code":"Px0000384075L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3640.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3640.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1516.54,"discounted_cash":1061.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 10X40MMX135CM AB35W10040135","code_information":[{"code":"Px0000384082L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 10X60MMX135CM","code_information":[{"code":"Px0000384083L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 12X40MMX135CM AB35W12040135","code_information":[{"code":"Px0000384084L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 12X60MMX135CM","code_information":[{"code":"Px0000384085L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYSTEM INCISION MGMT PREVENA PRE1001US","code_information":[{"code":"Px0000384110L","type":"CDM"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":1122.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATTRO 62CM 6947M62","code_information":[{"code":"Px0000384597L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO SUPERCROSS 120DEG 5306","code_information":[{"code":"Px0000384646L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":1195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X40MMX80CM B1040040","code_information":[{"code":"Px0000385266L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X20MMX80CM B1050020","code_information":[{"code":"Px0000385271L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X40MMX80CM B1050040","code_information":[{"code":"Px0000385272L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X60MMX80CM B1050060","code_information":[{"code":"Px0000385273L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X80MMX80CM B1050080","code_information":[{"code":"Px0000385274L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X100MMX80CM B1050100","code_information":[{"code":"Px0000385275L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X120MMX80CM","code_information":[{"code":"Px0000385276L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X20MMX80CM B1060020","code_information":[{"code":"Px0000385277L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X40MMX80CM B1060040","code_information":[{"code":"Px0000385278L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X60MMX80CM","code_information":[{"code":"Px0000385279L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X80MMX80CM B1060080","code_information":[{"code":"Px0000385280L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X100MMX80CM B1060100","code_information":[{"code":"Px0000385281L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X20MMX80CM B1070020","code_information":[{"code":"Px0000385283L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X40MMX80CM B1070040","code_information":[{"code":"Px0000385284L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X60MMX80CM","code_information":[{"code":"Px0000385285L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X80MMX80CM B1070080","code_information":[{"code":"Px0000385286L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X20MMX80CM B1080020","code_information":[{"code":"Px0000385289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X40MMX80CM B1080040","code_information":[{"code":"Px0000385290L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X60MMX80CM","code_information":[{"code":"Px0000385291L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X80MMX80CM B1080080","code_information":[{"code":"Px0000385292L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 9X20MMX80CM B1090020","code_information":[{"code":"Px0000385293L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 9X40MMX80CM B1090040","code_information":[{"code":"Px0000385294L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X20MMX80CM B1100020","code_information":[{"code":"Px0000385297L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X40MMX80CM B1100040","code_information":[{"code":"Px0000385298L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X60MMX80CM","code_information":[{"code":"Px0000385299L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 12X20MMX80CM B1120020","code_information":[{"code":"Px0000385301L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 12X40MMX80CM B1120040","code_information":[{"code":"Px0000385302L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 14X20MMX80CM","code_information":[{"code":"Px0000385305L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 14X40MMX80CM B1140040","code_information":[{"code":"Px0000385306L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 3X20MMX135CM B2030020","code_information":[{"code":"Px0000385309L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 3X40MMX135CM B2030040","code_information":[{"code":"Px0000385310L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X20MMX135CM B2040020","code_information":[{"code":"Px0000385311L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X40MMX135CM B2040040","code_information":[{"code":"Px0000385312L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X60MMX135CM B2040060","code_information":[{"code":"Px0000385313L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X80MMX135CM B2040080","code_information":[{"code":"Px0000385314L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X100MMX135CM B2040100","code_information":[{"code":"Px0000385315L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X120MMX135CM B2040120","code_information":[{"code":"Px0000385316L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X20MMX135CM B2050020","code_information":[{"code":"Px0000385317L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X40MMX135CM B2050040","code_information":[{"code":"Px0000385318L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X60MMX135CM B2050060","code_information":[{"code":"Px0000385319L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X80MMX135CM B2050080","code_information":[{"code":"Px0000385320L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X100MMX135CM B2050100","code_information":[{"code":"Px0000385321L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X120MMX135CM B2050120","code_information":[{"code":"Px0000385322L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X20MMX135CM B2060020","code_information":[{"code":"Px0000385323L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X40MMX135CM B2060040","code_information":[{"code":"Px0000385324L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X60MMX135CM B2060060","code_information":[{"code":"Px0000385325L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X80MMX135CM B2060080","code_information":[{"code":"Px0000385326L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X100MMX135CM B2060100","code_information":[{"code":"Px0000385327L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X120MMX135CM B2060120","code_information":[{"code":"Px0000385328L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X40MMX135CM B2070040","code_information":[{"code":"Px0000385330L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X60MMX135CM B2070060","code_information":[{"code":"Px0000385331L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7.0X80MMX135CM B2070080","code_information":[{"code":"Px0000385332L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X100MMX135CM B2070100","code_information":[{"code":"Px0000385333L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X20MMX135CM B2080020","code_information":[{"code":"Px0000385335L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X40MMX135CM B2080040","code_information":[{"code":"Px0000385336L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8.0X60MMX135CM B2080060","code_information":[{"code":"Px0000385337L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8.0X80MMX135CM B2080080","code_information":[{"code":"Px0000385338L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 9X20MMX135CM B2090020","code_information":[{"code":"Px0000385339L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 9.0X60MMX135CM B2090060","code_information":[{"code":"Px0000385341L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X20MMX135CM B2100020","code_information":[{"code":"Px0000385343L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X40MMX135CM B2100040","code_information":[{"code":"Px0000385344L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 1.0X60MMX135CM B2100060","code_information":[{"code":"Px0000385345L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 12X20MMX135CM B2120020","code_information":[{"code":"Px0000385347L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 12X40MMX135CM B2120040","code_information":[{"code":"Px0000385348L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ARMDA .035 14X40MMX135CM B2140040","code_information":[{"code":"Px0000385352L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X40X80CM","code_information":[{"code":"Px0000385591L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X60X80CM 101252860","code_information":[{"code":"Px0000385592L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X40X80CM 101252940","code_information":[{"code":"Px0000385597L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X60X80CM 101252960","code_information":[{"code":"Px0000385598L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X80X80CM 101252980","code_information":[{"code":"Px0000385599L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X40X80CM 101253040","code_information":[{"code":"Px0000385603L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X60X80CM 101253060","code_information":[{"code":"Px0000385604L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X80X80CM 101253080","code_information":[{"code":"Px0000385605L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 9X40X80CM 101253140","code_information":[{"code":"Px0000385609L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 10X40X80C 101253240","code_information":[{"code":"Px0000385615L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 10X60X80CM 101253260","code_information":[{"code":"Px0000385616L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 10X80X80C 101253280","code_information":[{"code":"Px0000385617L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X100X135 1012534100","code_information":[{"code":"Px0000385618L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X40X135 101253440","code_information":[{"code":"Px0000385621L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X60X135 101253460","code_information":[{"code":"Px0000385622L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X100X135 1012535100","code_information":[{"code":"Px0000385624L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X40X135 101253540","code_information":[{"code":"Px0000385627L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X60X135 101253560","code_information":[{"code":"Px0000385628L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X80X135 101253580","code_information":[{"code":"Px0000385629L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X100X135 1012536100","code_information":[{"code":"Px0000385630L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X40X135 101253640","code_information":[{"code":"Px0000385633L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X80X135 101253680","code_information":[{"code":"Px0000385635L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X20MMX135CM AB35W05020135","code_information":[{"code":"Px0000385723L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE CLEANER THRMBCTMY 135CM 700109XT","code_information":[{"code":"Px0000385786L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2695.0,"discounted_cash":1886.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X60MMX80CM AB35W06060080","code_information":[{"code":"Px0000386190L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 10X17MM80CM PXB351017080","code_information":[{"code":"Px0000386429L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 10X27MMX135CM PXB351027135","code_information":[{"code":"Px0000386435L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 3X80MMX135CM AB35W03080135","code_information":[{"code":"Px0000386461L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 3X120MMX135CM AB35W03120135","code_information":[{"code":"Px0000386465L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X20MMX80CM AB35W04020080","code_information":[{"code":"Px0000386468L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X20MMX135CM AB35W04020135","code_information":[{"code":"Px0000386469L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X80MMX135CM AB35W04080135","code_information":[{"code":"Px0000386473L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X100MMX135CM AB35W04100135","code_information":[{"code":"Px0000386475L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X120MMX135CM AB35W04120135","code_information":[{"code":"Px0000386477L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X20MMX80CM AB35W05020080","code_information":[{"code":"Px0000386481L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X40MMX135CM AB35W05040135","code_information":[{"code":"Px0000386483L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X60MMX135CM AB35W05060135","code_information":[{"code":"Px0000386485L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 5X80MMX135CM AB35W05080135","code_information":[{"code":"Px0000386487L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X20MMX135CM AB35W06020135","code_information":[{"code":"Px0000386493L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X80MMX80CM AB35W06080080","code_information":[{"code":"Px0000386496L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X100MMX80CM AB35W06100080","code_information":[{"code":"Px0000386497L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 7X20MMX135CM AB35W07020135","code_information":[{"code":"Px0000386503L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 9X20MMX135CM AB35W09020135","code_information":[{"code":"Px0000386510L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 9X40MMX135CM AB35W09040135","code_information":[{"code":"Px0000386512L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 10X20MMX80CM AB35W10020080","code_information":[{"code":"Px0000386515L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 10X20MMX135CM AB35W10020135","code_information":[{"code":"Px0000386516L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 4X150MMX135CM AB35W04150135","code_information":[{"code":"Px0000386524L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X150MMX80CM AB35W06150080","code_information":[{"code":"Px0000386527L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EVERX 6X200MMX80CM AB35W06200080","code_information":[{"code":"Px0000386528L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X120MMX150CM AB14W020120150","code_information":[{"code":"Px0000386531L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X20MMX150CM AB14W020020150","code_information":[{"code":"Px0000386533L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X40MMX150CM AB14W020040150","code_information":[{"code":"Px0000386535L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X40MMX150CM AB14W025040150","code_information":[{"code":"Px0000386539L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X80MMX150CM AB14W025080150","code_information":[{"code":"Px0000386541L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X120MMX150CM AB14W030120150","code_information":[{"code":"Px0000386543L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X40MMX150CM AB14W030040150","code_information":[{"code":"Px0000386547L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X80MMX150CM AB14W030080150","code_information":[{"code":"Px0000386549L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X120MMX150CM AB14W040120150","code_information":[{"code":"Px0000386557L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X40MMX150CM AB14W040040150","code_information":[{"code":"Px0000386561L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X80MMX150CM AB14W040080150","code_information":[{"code":"Px0000386563L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH KIT SNARE GN 30MM 120CM GN3000","code_information":[{"code":"Px0000386670L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":713.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR TCS TL 5FR HF TY","code_information":[{"code":"Px0000386721L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.71,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR I/R TL 5FR HF TY","code_information":[{"code":"Px0000386722L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 7120Q 65CM 7120Q65","code_information":[{"code":"Px0000386726L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 7122Q 58CM 7122Q58","code_information":[{"code":"Px0000386729L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 7120Q 65CM 7122Q65","code_information":[{"code":"Px0000386730L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD VENT QUICKFLEX OPT 86CM 1258T86","code_information":[{"code":"Px0000386733L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3596.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEV REVASC SOLITAIRE 4X5MM","code_information":[{"code":"Px0000386737L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":28984.0,"discounted_cash":20288.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RETRIEVER SOLITAIRE 4MM/20MM SFR420","code_information":[{"code":"Px0000386738L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":19760.0,"discounted_cash":13832.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RETREIVER SOLITAIRE 6MM/30MM","code_information":[{"code":"Px0000386740L","type":"CDM"}],"standard_charges":[{"gross_charge":20480.0,"discounted_cash":14336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REFLEX 5FR .058 8CM 115CM RFX05811508","code_information":[{"code":"Px0000386741L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4346.0,"discounted_cash":3042.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REFLEX 5FR .058 8CM 130CM RFX05813008","code_information":[{"code":"Px0000386743L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4346.0,"discounted_cash":3042.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REFLEX 5FR .072 8CM 115CM","code_information":[{"code":"Px0000386745L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3338.0,"discounted_cash":2336.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MARK MIC 2.8F .027X150X10 FA551501030","code_information":[{"code":"Px0000386747L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SLCT 5F 120 BER PNS5F120BER","code_information":[{"code":"Px0000387041L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI EVRFLX 6X200MMX120 PRB3506200120","code_information":[{"code":"Px0000387069L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":9442.0,"discounted_cash":6609.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PEDS SM VSL 4F DUAL 3274355","code_information":[{"code":"Px0000387495L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":399.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON MAX 6F STR TIP PNML6F088804","code_information":[{"code":"Px0000388046L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 2D .35 CUBE 12X20 M001363620","code_information":[{"code":"Px0000388147L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1991.0,"discounted_cash":1393.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 35 CUBE 20X40 M001363830","code_information":[{"code":"Px0000388150L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2612.0,"discounted_cash":1828.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DCP GRSP RAPTOR 2.4MMX230CM 00711177","code_information":[{"code":"Px0000388426L","type":"CDM"}],"standard_charges":[{"gross_charge":564.96,"discounted_cash":395.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CVC POWER KIT 8.5 FR","code_information":[{"code":"Px0000388489L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.41,"discounted_cash":493.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT SHEATH LASER GLIDE LT 14FR 500302","code_information":[{"code":"Px0000388538L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":9646.0,"discounted_cash":6752.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THERMOCOOL SF 8F F CRV D131503","code_information":[{"code":"Px0000388714L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":9985.76,"discounted_cash":6990.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYS BOWEL MGMT DIGNICARE ADV SMS002","code_information":[{"code":"Px0000388838L","type":"CDM"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICDD FORTIFY ASSURA DR 40","code_information":[{"code":"Px0000389019L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":62173.0,"discounted_cash":43521.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D UNIFY ASSURA 40 CD3257","code_information":[{"code":"Px0000389029L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":84625.0,"discounted_cash":59237.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI WFLX 8.5FR 10X60MM M00574780","code_information":[{"code":"Px0000389046L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":4681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI WFLX 8.5FR 10X80MM M00574790","code_information":[{"code":"Px0000389047L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":4681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT SHEATH LASER GLIDE LT 16FR 500303","code_information":[{"code":"Px0000389301L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":9646.0,"discounted_cash":6752.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHERE ORNG QUADRA 30-60 V225QS","code_information":[{"code":"Px0000389648L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4674.0,"discounted_cash":3271.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ECO LSONAV VAR 22 POLE 7F D134301","code_information":[{"code":"Px0000389716L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":7647.43,"discounted_cash":5353.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS 3MAX 3MAXC 3MAXC","code_information":[{"code":"Px0000389761L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4337.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLTZ 4 6X11.0M 9AVP038006","code_information":[{"code":"Px0000389905L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3243.0,"discounted_cash":2270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLTZ 4 8X13.5M 9AVP038008","code_information":[{"code":"Px0000389906L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3243.0,"discounted_cash":2270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT DRNGE ASPIRA PERI BASIC 4992209","code_information":[{"code":"Px0000389939L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.06,"discounted_cash":1577.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED TRAN JEJU 18-3.5-45 0270183545","code_information":[{"code":"Px0000389942L","type":"CDM"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC G-WIRE RUNTHRU EXT NS 259092","code_information":[{"code":"Px0000389948L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRO 6F 4CM MRKR TIP PSS6F4MT","code_information":[{"code":"Px0000390180L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.81,"discounted_cash":134.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 6X16MMX80CM","code_information":[{"code":"Px0000390182L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 6X21MMX80CM 101262229","code_information":[{"code":"Px0000390184L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 6X39MMX80CM 101262239","code_information":[{"code":"Px0000390185L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 7X16MMX80CM","code_information":[{"code":"Px0000390188L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 7X29MMX80CM 101262329","code_information":[{"code":"Px0000390190L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 7X39MMX80CM 101262339","code_information":[{"code":"Px0000390191L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 8X29MMX80CM 101262429","code_information":[{"code":"Px0000390194L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 8X39MMX80CM 101262439","code_information":[{"code":"Px0000390195L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 8X59X80 101262459","code_information":[{"code":"Px0000390196L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 9X29X80 101262529","code_information":[{"code":"Px0000390198L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 9X39X80 101262539","code_information":[{"code":"Px0000390199L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 10X29MMX80CM 101262629","code_information":[{"code":"Px0000390202L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 10X39MMX80CM 101262639","code_information":[{"code":"Px0000390203L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 10X59X80 101262659","code_information":[{"code":"Px0000390204L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 7X59X80 101262919","code_information":[{"code":"Px0000390207L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 6X29X135 101262929","code_information":[{"code":"Px0000390208L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 7X16X135 101263016","code_information":[{"code":"Px0000390212L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 7X29X135 101263029","code_information":[{"code":"Px0000390214L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 7X39X135 101263039","code_information":[{"code":"Px0000390215L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT OMNI ELT 8X19MMX135CM 101263119","code_information":[{"code":"Px0000390217L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 8X29X135 101263129","code_information":[{"code":"Px0000390218L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 8X39X135 101263139","code_information":[{"code":"Px0000390219L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 9X19X135 101263219","code_information":[{"code":"Px0000390221L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 10X39X135 101263339","code_information":[{"code":"Px0000390227L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.54,"discounted_cash":1061.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATRO 6935 58CM 693558","code_information":[{"code":"Px0000390417L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CRYOABLT ARTIC ADV 28MM 2AF284","code_information":[{"code":"Px0000390530L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":12134.0,"discounted_cash":8493.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET TUBING COOL POINT 85785","code_information":[{"code":"Px0000390545L","type":"CDM"}],"standard_charges":[{"gross_charge":409.15,"discounted_cash":286.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1.5MMX2CM M0035421520","code_information":[{"code":"Px0000390857L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1.5MMX3CM M0035421530","code_information":[{"code":"Px0000390858L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1.5MMX4CM M0035421540","code_information":[{"code":"Px0000390859L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5042.0,"discounted_cash":3529.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT CATH CLEARVUE 8FR 1608062","code_information":[{"code":"Px0000391844L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1417.0,"discounted_cash":991.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV PRESS INJ 7FR 16CM KT CDC42703XP1A","code_information":[{"code":"Px0000392515L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":395.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ICE VIEWFLEX XTRA 9FR D087031","code_information":[{"code":"Px0000392588L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":6225.0,"discounted_cash":4357.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1214.0,"discounted_cash":849.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLTZ 4 4MM .038 9AVP038004","code_information":[{"code":"Px0000392755L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":3243.0,"discounted_cash":2270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLTZ 4 5MM .038 9AVP038005","code_information":[{"code":"Px0000392756L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":3243.0,"discounted_cash":2270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLUG VASCULAR AMPLTZ 4 7MM .038 9AVP038007","code_information":[{"code":"Px0000392757L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":3243.0,"discounted_cash":2270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EMERGE MR PUSH 8X1.5MM H7493919008150","code_information":[{"code":"Px0000392828L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EMERGE MR PUSH 15X1.5MM H7493919015150","code_information":[{"code":"Px0000392854L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN EMERGE PUSH OTW 15X1.5MM H7493919215150","code_information":[{"code":"Px0000392915L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRANIAL ACCESS CSF KIT INSHITHRZN","code_information":[{"code":"Px0000393045L","type":"CDM"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":949.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SCEPTER C OCCL 4X10MM BC0410C","code_information":[{"code":"Px0000393080L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4248.92,"discounted_cash":2974.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SCEPTER XC OCCL 4X11MM BC0411XC","code_information":[{"code":"Px0000393081L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5061.57,"discounted_cash":3543.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN VENOUS 21F X 18CM 96530021","code_information":[{"code":"Px0000393291L","type":"CDM"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":781.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP CRYO 3 CRV MD","code_information":[{"code":"Px0000393298L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CROSSING VIANCE STD 150CM VNCSD150","code_information":[{"code":"Px0000393691L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4929.0,"discounted_cash":3450.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RE-ENTRY 135 3.75X20 ENB37520135","code_information":[{"code":"Px0000393693L","type":"CDM"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":6673.0,"discounted_cash":4671.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE VASC ENTEER STD300 .014 ENWSD014300","code_information":[{"code":"Px0000393695L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE VASC ENTEER STIF300 .014 ENWSF014300","code_information":[{"code":"Px0000393696L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":752.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NASAL BRIDLE","code_information":[{"code":"Px0000394903L","type":"CDM"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIM BARE 3D 4MMX6 APB463DSS","code_information":[{"code":"Px0000394927L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIM BARE 3D 4MMX12 APB4123DSS","code_information":[{"code":"Px0000394930L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIM BARE 3D 5MMX10 APB5103DSS","code_information":[{"code":"Px0000394932L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIM BARE 3D 5MMX15 APB5153DSS","code_information":[{"code":"Px0000394933L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIM BARE 3D 6MMX20 APB6203DSS","code_information":[{"code":"Px0000394936L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATRO S DF4 55CM 6935M55","code_information":[{"code":"Px0000395023L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATRO S DF4 72CM 6935M72","code_information":[{"code":"Px0000395025L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":7257.0,"discounted_cash":5079.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI WFLX 8FR 8X60MM","code_information":[{"code":"Px0000395029L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6843.02,"discounted_cash":4790.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI WFLX 8FR 8X80MM","code_information":[{"code":"Px0000395030L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5585.0,"discounted_cash":3909.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EPICRD AGILIS EPI 8.5 G402047","code_information":[{"code":"Px0000396049L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.0,"discounted_cash":2329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLEXCATH ADV 12FR 4FC12","code_information":[{"code":"Px0000396074L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRSG VAC VERAFLO CLEANSE MED ULTVCL05MD","code_information":[{"code":"Px0000397887L","type":"CDM"},{"code":"A6550","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":459.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIO DECANAV F CURVE R7F282CT","code_information":[{"code":"Px0000398019L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":3703.16,"discounted_cash":2592.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN VALVPLSTY NUC-X 22 MMX5CM","code_information":[{"code":"Px0000398318L","type":"CDM"}],"standard_charges":[{"gross_charge":3268.0,"discounted_cash":2287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVUS PV.035 .038 90CM 88901","code_information":[{"code":"Px0000398385L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":2964.0,"discounted_cash":2074.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DLYS MHRKR STR DL 8F KIT 8832539003","code_information":[{"code":"Px0000398682L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SCORING 6.0X40MMX90CM 20926040","code_information":[{"code":"Px0000400947L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":2121.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRN MLT MLOKE 14FR 45CM G09768","code_information":[{"code":"Px0000401292L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MUSTNG 7.0X60MMX75CM H74939171070670","code_information":[{"code":"Px0000401428L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC PENUMBRA PXSLIM045 PXSLIM045","code_information":[{"code":"Px0000401518L","type":"CDM"}],"standard_charges":[{"gross_charge":3017.0,"discounted_cash":2111.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DEL MIC PX SLIM .025 STR PXSLIMSTR","code_information":[{"code":"Px0000401519L","type":"CDM"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1974.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE GLD ANG 5FR 100CM RFZV95110M","code_information":[{"code":"Px0000401523L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEST TUBE EXODUS 8FR H965101431","code_information":[{"code":"Px0000401606L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":600.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE CLN THRMB 15MMX65CM 700015","code_information":[{"code":"Px0000410887L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1706.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE CLN THROMB 15MMX135CM","code_information":[{"code":"Px0000410888L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":3158.0,"discounted_cash":2210.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR 2L 4FR W/SH","code_information":[{"code":"Px0000411103L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":899.0,"discounted_cash":629.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIAG ULT ACUNAV REPR","code_information":[{"code":"Px0000411188L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":2641.0,"discounted_cash":1848.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN FEM B-MDCUS 21FR 30IN KT","code_information":[{"code":"Px0000411796L","type":"CDM"}],"standard_charges":[{"gross_charge":1428.0,"discounted_cash":999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN FEM B-MDCUS 23FR 30IN KT","code_information":[{"code":"Px0000411797L","type":"CDM"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBING SUCT ASPIR MAX PST2","code_information":[{"code":"Px0000411936L","type":"CDM"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC 400 CMPLX XSFT 04 4006C0406","code_information":[{"code":"Px0000412654L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6367.0,"discounted_cash":4456.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC 400 CRV X-SFT 2X30MM 4006U0203","code_information":[{"code":"Px0000412656L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5298.0,"discounted_cash":3708.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC TAR HEL ULT 1.5MMX3CM M0035431530","code_information":[{"code":"Px0000412939L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3342.0,"discounted_cash":2339.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2731.0,"discounted_cash":1911.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2731.0,"discounted_cash":1911.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2552.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2731.0,"discounted_cash":1911.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ANGIO NAVICROSS STR 65CM NC35650","code_information":[{"code":"Px0000414306L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.33,"discounted_cash":724.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ANGIO NAVICROSS STR 135CM NC35130","code_information":[{"code":"Px0000414307L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.33,"discounted_cash":724.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HANDLE COIL VASC DETACH DH1","code_information":[{"code":"Px0000415010L","type":"CDM"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":716.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER VASC OPTION ELITE 30MM 352506070E","code_information":[{"code":"Px0000416206L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":3960.6,"discounted_cash":2772.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DLYS GLDPTH 14.5F 19CM KT 5393190","code_information":[{"code":"Px0000416208L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":888.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DLYS GLDEPH 14.5F 23CM KT 5393230","code_information":[{"code":"Px0000416209L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":888.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CASSETTE PURGE IMPELLA CTRLR 00430003","code_information":[{"code":"Px0000416272L","type":"CDM"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":494.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC TRANSEPT 7FR 60CM 406802","code_information":[{"code":"Px0000417874L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.08,"discounted_cash":259.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LV QUARTET LEAD 1458Q/86 1458Q86","code_information":[{"code":"Px0000417885L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SOLITAIRE2 FR REVASC 6X30","code_information":[{"code":"Px0000419026L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN GUIDE CELLO 8FR 1610580","code_information":[{"code":"Px0000419027L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.0,"discounted_cash":2329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN GUIDE CELLO 9FR","code_information":[{"code":"Px0000419028L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3110.0,"discounted_cash":2177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 1.5X15MM 101240215A","code_information":[{"code":"Px0000419043L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 2.0X8MM 101240308A","code_information":[{"code":"Px0000419044L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 2.0X12MM 101240312A","code_information":[{"code":"Px0000419045L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINITREK II OTW 2.0X20MM 101240320A","code_information":[{"code":"Px0000419047L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC 400 CMPLXXSFT 03 4006C0304","code_information":[{"code":"Px0000419766L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5803.0,"discounted_cash":4062.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC TAR HEL ULT 1MMX2CM M0035431020","code_information":[{"code":"Px0000419856L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3342.0,"discounted_cash":2339.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC TAR HEL ULT 1MMX3CM M0035431030","code_information":[{"code":"Px0000419857L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3342.0,"discounted_cash":2339.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER STABILIT DMND TIP","code_information":[{"code":"Px0000420258L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":612.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT IMPELLA PUMP CATH 005062","code_information":[{"code":"Px0000421852L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":55000.0,"discounted_cash":38500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CP IMPELLA 14F 00480003","code_information":[{"code":"Px0000421877L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":55000.0,"discounted_cash":38500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14F /1. X 15C","code_information":[{"code":"Px0000421901L","type":"CDM"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 8F 13CM SS8","code_information":[{"code":"Px0000424286L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 6F 13CM SS6","code_information":[{"code":"Px0000424287L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 9F 13CM SS9","code_information":[{"code":"Px0000424288L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 7F 13CM SS7","code_information":[{"code":"Px0000424289L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT CATH CLEARVUE SLIM 8FR","code_information":[{"code":"Px0000424446L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ40 6X40MMX75CM","code_information":[{"code":"Px0000424468L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ40 7X40MMX75CM","code_information":[{"code":"Px0000424469L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ40 8X40MMX75CM CQF7584","code_information":[{"code":"Px0000424470L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAIN CHEST ASPIRA W/VOUCH 4992507","code_information":[{"code":"Px0000425652L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":2713.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC JETSTREAM ATHERECTOMY CATH 2.4MM 112266001","code_information":[{"code":"Px0000427184L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":9180.0,"discounted_cash":6426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER VASC FEM DENALI DL900F DL900F","code_information":[{"code":"Px0000427229L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5176.0,"discounted_cash":3623.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FILTER VASC JUG DENALI DL900J DL900J","code_information":[{"code":"Px0000427230L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5176.0,"discounted_cash":3623.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 5MMX20CM RBY2C0520","code_information":[{"code":"Px0000427253L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 6MMX20CM RBY2C0620","code_information":[{"code":"Px0000427254L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 7MMX25CM RBY2C0725","code_information":[{"code":"Px0000427255L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 9MMX30CM RBY2C0930","code_information":[{"code":"Px0000427257L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 10MMX35CM RBY2C1035","code_information":[{"code":"Px0000427258L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 12MMX40CM RBY2C1240","code_information":[{"code":"Px0000427259L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 14MMX60CM RBY2C1460","code_information":[{"code":"Px0000427260L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 16MMX60CM RBY2C1660","code_information":[{"code":"Px0000427261L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 18MMX57CM RBY2C1857","code_information":[{"code":"Px0000427262L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 20MMX60CM RBY2C2060","code_information":[{"code":"Px0000427263L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 24MMX57CM RBY2C2457","code_information":[{"code":"Px0000427264L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 28MMX60CM RBY2C2860","code_information":[{"code":"Px0000427265L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 32MMX60CM RBY2C3260","code_information":[{"code":"Px0000427266L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 3MMX15CM RBY4C0315","code_information":[{"code":"Px0000427267L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HANDLE DETACH COIL RBY RH1","code_information":[{"code":"Px0000427272L","type":"CDM"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":692.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 9.5F 13 SS95","code_information":[{"code":"Px0000427749L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HMII SYST CONTROLLER PCKT CONT","code_information":[{"code":"Px0000427757L","type":"CDM"},{"code":"Q0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":14915.0,"discounted_cash":10440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR I/R TL 6FR HF TY","code_information":[{"code":"Px0000428616L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.71,"discounted_cash":942.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MARKER FUSION COIL 18 GGA NDL MTCTXFC1051820","code_information":[{"code":"Px0000428638L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE VASC WHLY STD 35X175","code_information":[{"code":"Px0000428837L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.12,"discounted_cash":199.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL FNSH SYS 10 2MMX4CM","code_information":[{"code":"Px0000429017L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1845.0,"discounted_cash":1291.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL FNSH SYS 10 3MMX6CM","code_information":[{"code":"Px0000429022L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1845.0,"discounted_cash":1291.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA DR NX GEN CD235740C","code_information":[{"code":"Px0000431609L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18489.0,"discounted_cash":12942.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA DR DF4 NXGEN CD235740Q","code_information":[{"code":"Px0000431610L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":20824.0,"discounted_cash":14576.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18521.24,"discounted_cash":12964.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD-D ELLIPSE DR 36 DF4 NX GEN CD241136Q","code_information":[{"code":"Px0000431612L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":20824.0,"discounted_cash":14576.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA VR NX GEN CD135740C","code_information":[{"code":"Px0000431613L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":17262.0,"discounted_cash":12083.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17262.0,"discounted_cash":12083.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D QUADRA ASSURA DF4 NX GEN","code_information":[{"code":"Px0000431618L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":76909.0,"discounted_cash":53836.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D UNIFY ASSURA NX GEN CD335740C","code_information":[{"code":"Px0000431619L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":22965.0,"discounted_cash":16075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D UNIFY ASSURA DF4 NX GEN CD335740Q","code_information":[{"code":"Px0000431620L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":22965.0,"discounted_cash":16075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN RAPIDX 3X40MMX170CM A14BX030040170","code_information":[{"code":"Px0000431901L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 1.20MMX12MM 101240112Z","code_information":[{"code":"Px0000432032L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CTRLR BACK UP PKT HRTMTE II","code_information":[{"code":"Px0000432200L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1766.0,"discounted_cash":1236.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BAG PC CONSOL HRTMTE II LT","code_information":[{"code":"Px0000432201L","type":"CDM"},{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.0,"discounted_cash":886.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BAG PC CONSOL HRTMTE II RT","code_information":[{"code":"Px0000432202L","type":"CDM"},{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HOLTER VEST, SMALL POCKET CONTROLLER","code_information":[{"code":"Px0000432203L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.0,"discounted_cash":1078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HOLTER VEST, MEDIUM POCKET CONTROLLER","code_information":[{"code":"Px0000432204L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.0,"discounted_cash":976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HOLTER VEST, LARGE POCKET CONTROLLER","code_information":[{"code":"Px0000432205L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.37,"discounted_cash":1078.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHOWER BAG POCKET CONTROLLER","code_information":[{"code":"Px0000432207L","type":"CDM"},{"code":"Q0501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1755.0,"discounted_cash":1228.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WEARABLE ACCESS KIT","code_information":[{"code":"Px0000432208L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":637.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 10F 13CM","code_information":[{"code":"Px0000432257L","type":"CDM"}],"standard_charges":[{"gross_charge":286.7,"discounted_cash":200.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 LNG 6F 23CM SSL6","code_information":[{"code":"Px0000432261L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.48,"discounted_cash":333.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAGE 2 LNG 8FR 23CM SSL8","code_information":[{"code":"Px0000432262L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.48,"discounted_cash":333.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 LNG 10F 23CM","code_information":[{"code":"Px0000432264L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.48,"discounted_cash":333.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1327.0,"discounted_cash":928.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1327.0,"discounted_cash":928.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PLNDRMPPK V/T 14.5/28","code_information":[{"code":"Px0000432417L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":928.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PLNDRM P PK VIT 14.5/33","code_information":[{"code":"Px0000432418L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.66,"discounted_cash":892.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE CLSR VASC MYNX 6/7FR MX6721","code_information":[{"code":"Px0000433224L","type":"CDM"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY SHEATH INTRO PERC 9FR CDC29903X1A","code_information":[{"code":"Px0000433553L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.98,"discounted_cash":422.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN TRUE .035 22X4.5 0224512","code_information":[{"code":"Px0000433979L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.0,"discounted_cash":1691.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN TRUE BAV .035 26X4.5 0264513","code_information":[{"code":"Px0000433981L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.0,"discounted_cash":1691.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE LARY PRVX 9/55","code_information":[{"code":"Px0000434309L","type":"CDM"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":606.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEARTWARE CONTROLLER","code_information":[{"code":"Px0000434356L","type":"CDM"},{"code":"Q0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":18876.0,"discounted_cash":13213.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEARTWARE SHOWER BAG US","code_information":[{"code":"Px0000434361L","type":"CDM"},{"code":"Q0501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEARTWARE WAIST PACK","code_information":[{"code":"Px0000434362L","type":"CDM"},{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":1023.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEARTWARE SHOULDER PACK","code_information":[{"code":"Px0000434363L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1548.0,"discounted_cash":1083.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO SHEATH SENTRANT 14F 28CM SENSH1428W","code_information":[{"code":"Px0000436080L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO SHEATH SENTRANT 16F 28CM SENSH1628W","code_information":[{"code":"Px0000436081L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SOUNDSTAR ECO SMS 10FR","code_information":[{"code":"Px0000437238L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":7490.0,"discounted_cash":5243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 1.20MMX15MM 101240115Z","code_information":[{"code":"Px0000437273L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 1.5X20MM 101240220A","code_information":[{"code":"Px0000437276L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS 5 MAX ACE 5MAXACE132","code_information":[{"code":"Px0000437345L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7124.0,"discounted_cash":4986.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT DRNG ASPIRA PLEUR STRT 4992509","code_information":[{"code":"Px0000437847L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ40 10X40MMX75CM","code_information":[{"code":"Px0000437864L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH U-THEN DAW MEUL 6.3FR 25CM G51595","code_information":[{"code":"Px0000437917L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 10X30 NV1030HELIX","code_information":[{"code":"Px0000437930L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX NYL 2MMX4CM NV24HELIX","code_information":[{"code":"Px0000437931L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX NYL 2MMX6CM NV26HELIX","code_information":[{"code":"Px0000437932L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX NYL 2MMX8CM NV28HELIX","code_information":[{"code":"Px0000437933L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX NYL 3MMX4CM NV34HELIX","code_information":[{"code":"Px0000437934L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX NYL 3MMX8CM NV38HELIX","code_information":[{"code":"Px0000437935L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX NYL 4X10 NV410HELIX","code_information":[{"code":"Px0000437936L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX NYL 4MMX8CM NV48HELIX","code_information":[{"code":"Px0000437937L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 5X15 NV515HELIX","code_information":[{"code":"Px0000437938L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 5X20 NV520HELIX","code_information":[{"code":"Px0000437939L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 6X20 NV620HELIX","code_information":[{"code":"Px0000437940L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 7X30 NV730HELIX","code_information":[{"code":"Px0000437941L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 8X30 NV830HELIX","code_information":[{"code":"Px0000437942L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 9X30 NV930HELIX","code_information":[{"code":"Px0000437943L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 12X30 PV1230HELIX","code_information":[{"code":"Px0000437944L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 14X30 PV1430HELIX","code_information":[{"code":"Px0000437945L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 16X40 PV1640HELIX","code_information":[{"code":"Px0000437946L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 18X40 PV1840HELIX","code_information":[{"code":"Px0000437947L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL CONCERTO HLX 20X50 PV2050HELIX","code_information":[{"code":"Px0000437948L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET XL SFT 10MMX30CM","code_information":[{"code":"Px0000438140L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7961.0,"discounted_cash":5572.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX15CM RBY2C0415","code_information":[{"code":"Px0000439041L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX30CM RBY2C0430","code_information":[{"code":"Px0000439042L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX35CM RBY2C0435","code_information":[{"code":"Px0000439043L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 5MMX30CM RBY2C0530","code_information":[{"code":"Px0000439045L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 6MMX30CM RBY2C0630","code_information":[{"code":"Px0000439046L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 8MMX40CM RBY2C0840","code_information":[{"code":"Px0000439047L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 12MMX60CM RBY2C1260","code_information":[{"code":"Px0000439048L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 2MMX2CM RBY4C0202","code_information":[{"code":"Px0000439050L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 2MMX4CM RBY4C0204","code_information":[{"code":"Px0000439051L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 3MMX5CM RBY4C0305","code_information":[{"code":"Px0000439052L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 4MMX6CM RBY4C0406","code_information":[{"code":"Px0000439053L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 8MMX60CM RBY4C0860","code_information":[{"code":"Px0000439055L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPXSOFT 16MMX50CM RBY4C1650","code_information":[{"code":"Px0000439056L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 400 RBY CPXSOFT 20MMX60CM RBY4C2060","code_information":[{"code":"Px0000439057L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATRO 65CM 693565","code_information":[{"code":"Px0000439064L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT RETRIEV SNARE SHEATH 20MM SRK30","code_information":[{"code":"Px0000439078L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.86,"discounted_cash":1137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE ASAHI ASTATO XS20 PAGH143392","code_information":[{"code":"Px0000439224L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD TENDRIL PACE STS 65CM 2088TC65","code_information":[{"code":"Px0000439783L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL F-IDC 2D 2MM X 4CM M001361480","code_information":[{"code":"Px0000440016L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":866.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL F-IDC 2D 2MM X 6CM M001361490","code_information":[{"code":"Px0000440017L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":866.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT GLIDESHEATH SLNDR 6FR 10CM 801060","code_information":[{"code":"Px0000440134L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LSR TURB ELT OTW 2.3X125 423135","code_information":[{"code":"Px0000440585L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":8278.0,"discounted_cash":5794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LSR TURB ELT RX 0.9X-80 410154","code_information":[{"code":"Px0000440586L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":8278.0,"discounted_cash":5794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CODA 9FR 32MMX120CM G03831","code_information":[{"code":"Px0000441101L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1524.0,"discounted_cash":1066.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER MIC STIFFEN 4 FR KT KIT01199","code_information":[{"code":"Px0000441330L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH AGILIS CURL LRG 8.5FR - REP","code_information":[{"code":"Px0000441595L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":1372.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE ORB ATHE MICRO 1.25 145 DBP125MICRO145","code_information":[{"code":"Px0000441652L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":10187.0,"discounted_cash":7130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SCREW LGCY MLT-AXL SS 6.5X30MM 75646530","code_information":[{"code":"Px0000442434L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1815.0,"discounted_cash":1270.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD CAPSURE FIX NOVUS 507665","code_information":[{"code":"Px0000443129L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLLAR VISTA TLSO","code_information":[{"code":"Px0000445828L","type":"CDM"},{"code":"L0464","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.0,"discounted_cash":697.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 1.5X40MMX150CM AB14W015040150","code_information":[{"code":"Px0000446987L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X60MMX150CM AB14W030060150","code_information":[{"code":"Px0000446997L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X60MMX150CM AB14W040060150","code_information":[{"code":"Px0000447005L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 SFT 10 X 40CM M0036121040","code_information":[{"code":"Px0000447354L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":4130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 SFT 6 X 20CM M0036126200","code_information":[{"code":"Px0000447360L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":4130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL DETACH 360 SFT 8 X 30CM M0036128300","code_information":[{"code":"Px0000447362L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":4130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BALL COMPLIANT 3X10MM M003SRC03100","code_information":[{"code":"Px0000447365L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BALL COMPLIANT 4 X 10MM M003SRC04100","code_information":[{"code":"Px0000447366L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN SUPR COMPL 3X5MM M003SSC03050","code_information":[{"code":"Px0000447368L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BALL SUPR COMPL 4X10MM M003SSC04100","code_information":[{"code":"Px0000447369L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BALL SUPR COMPL 4 X 7MM M003SSC04070","code_information":[{"code":"Px0000447370L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BALL SUPR COMPL 7X7MM","code_information":[{"code":"Px0000447372L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENV AIGIS R LARGE US IUP CMRM6133","code_information":[{"code":"Px0000448489L","type":"CDM"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3055.0,"discounted_cash":2138.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS INDIGO 3 3.4F 154CM CAT3","code_information":[{"code":"Px0000448633L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3919.0,"discounted_cash":2743.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS INDIGO 5 5F 136CM CAT5","code_information":[{"code":"Px0000448634L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3919.0,"discounted_cash":2743.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHR EMBOZENE 100 2ML 0103010100211","code_information":[{"code":"Px0000448687L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHR EMBOZENE 700 2ML 17020S1","code_information":[{"code":"Px0000448689L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHERES ONCOZENE 100 2ML 0603010100202","code_information":[{"code":"Px0000448690L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4959.0,"discounted_cash":3471.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACER ASSURITY DR RF","code_information":[{"code":"Px0000449103L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-P ALLURE RF PM3222","code_information":[{"code":"Px0000449107L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":11206.0,"discounted_cash":7844.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD OPTISURE 210 DF1 65CM LDA21065","code_information":[{"code":"Px0000449114L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD OPTISURE DF4 58CM ACT SGL LDA210Q58","code_information":[{"code":"Px0000449116L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD OPTISURE DF4 65CM ACT SGL LDA210Q65","code_information":[{"code":"Px0000449117L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6443.0,"discounted_cash":4510.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD 3830 SELECT SECURE 74CM 383074","code_information":[{"code":"Px0000449127L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":892.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD CAPSURE SENSE 4074 45CM 407445","code_information":[{"code":"Px0000449133L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD CAPSURE SENSE 4074 65CM 407465","code_information":[{"code":"Px0000449134L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT CATH CLEARVUE SLIM 6FR 1616000","code_information":[{"code":"Px0000449208L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.0,"discounted_cash":1146.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RESOLVE LKG DRNGE 14FR","code_information":[{"code":"Px0000449398L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 4.5MMX80MMX120CM 6FR S45080120P6","code_information":[{"code":"Px0000449402L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4558.0,"discounted_cash":3190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 4.5MMX60MMX120CM 6FR S45060120P6","code_information":[{"code":"Px0000449403L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4558.0,"discounted_cash":3190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5MMX100MMX120CM 6FR S55100120P6","code_information":[{"code":"Px0000449404L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4558.0,"discounted_cash":3190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5X150X120C S55150120P6","code_information":[{"code":"Px0000449406L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV MAC 2 L 9FR DISTAL CDC21242X1A","code_information":[{"code":"Px0000449436L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":499.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 4.5MMX30MMX120CM 6F S45030120P6","code_information":[{"code":"Px0000449677L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4558.0,"discounted_cash":3190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI SUPERA 4.5X120X120 S45120120P6","code_information":[{"code":"Px0000449680L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4558.0,"discounted_cash":3190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5MMX40MMX120CM 6FR S55040120P6","code_information":[{"code":"Px0000449683L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4558.0,"discounted_cash":3190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5MMX60MMX120CM 6FR S55060120P6","code_information":[{"code":"Px0000449684L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4558.0,"discounted_cash":3190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI SUPERA 6.5X80X120 S65080120P6","code_information":[{"code":"Px0000449690L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 6.5MMX150MMX120CM 6FR S65150120P6","code_information":[{"code":"Px0000449693L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PRONTO V4 EXTRACT 4006","code_information":[{"code":"Px0000449890L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":895.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHR EMBOZENE 200 2MLYL 12020S1","code_information":[{"code":"Px0000449898L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.76,"discounted_cash":709.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPR EMBOZENE 500 2ML RD 15020S1","code_information":[{"code":"Px0000449899L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SMRT TCH 8F BI FJ CRV D132704","code_information":[{"code":"Px0000453697L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LOOP RECORDER REVEA LNQ11","code_information":[{"code":"Px0000454083L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":11543.0,"discounted_cash":8080.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC DIREXION 021 BERN 130 M001195240","code_information":[{"code":"Px0000454186L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":1155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC DIREXION 021 BERN 155 M001195250","code_information":[{"code":"Px0000454187L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":1155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC DIREXION 021 J 130 M001195270 M001195270","code_information":[{"code":"Px0000454188L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":1155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENV AIGIS R MED US IUP CMRM6122","code_information":[{"code":"Px0000454305L","type":"CDM"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3055.0,"discounted_cash":2138.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTROD ONE-STEP SUPRAPUBIC G26648","code_information":[{"code":"Px0000454327L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYSTEM DETACHMENT INZONE M00345100950","code_information":[{"code":"Px0000454415L","type":"CDM"}],"standard_charges":[{"gross_charge":755.04,"discounted_cash":528.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 3D 4MMX8CM M0036154080","code_information":[{"code":"Px0000454420L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4700.0,"discounted_cash":3290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET 3D 5MMX10CM M0036155100","code_information":[{"code":"Px0000454421L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4923.0,"discounted_cash":3446.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PNTRY NAV ECO CV 7F 262 D D128211","code_information":[{"code":"Px0000454640L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":5238.0,"discounted_cash":3666.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO HDWY DUO 156CM MC162156S","code_information":[{"code":"Px0000454930L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2564.14,"discounted_cash":1794.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO HDWY DUO 167CM MC162167S","code_information":[{"code":"Px0000454931L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3276.43,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC HEMO 8FR 90CM 5489001","code_information":[{"code":"Px0000455461L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.12,"discounted_cash":476.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LUBRICANT ROTAGLIDE H7492354800162","code_information":[{"code":"Px0000456196L","type":"CDM"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PNTRY NAV ECO CV 7F 262 F D128208","code_information":[{"code":"Px0000456609L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":5238.0,"discounted_cash":3666.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY REBEL MR 3.00X8","code_information":[{"code":"Px0000457954L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY REBEL MR 4.00X8","code_information":[{"code":"Px0000457956L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL F-IDC 2D 14MMX50CM M001361930","code_information":[{"code":"Px0000458040L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2442.0,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL F-IDC 2D 18MMX50CM M001361940","code_information":[{"code":"Px0000458041L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2442.0,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL F-IDC 2D 20MMX50CM M001361950","code_information":[{"code":"Px0000458042L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2442.0,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN DIL CATH 8FR 16MMX4CMX120CM","code_information":[{"code":"Px0000458177L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":978.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN DIL CATH 8FR 18MMX4CMX120CM ATG120184","code_information":[{"code":"Px0000458178L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.27,"discounted_cash":999.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN DIL CATH 9FR 20MMX4CMX120CM ATG120204","code_information":[{"code":"Px0000458179L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ATTAIN PERFORMA 429888","code_information":[{"code":"Px0000458188L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT CATH CLEARVUE INT 8FR 1618000","code_information":[{"code":"Px0000458202L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1417.0,"discounted_cash":991.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRILL BONE VECTOR","code_information":[{"code":"Px0000458208L","type":"CDM"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":612.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 10X5X120CM VBH100502A","code_information":[{"code":"Px0000458346L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9288.26,"discounted_cash":6501.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 10X10X120 VBH101002A","code_information":[{"code":"Px0000458347L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9180.0,"discounted_cash":6426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 13X10X120 VBH131002A","code_information":[{"code":"Px0000458354L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9965.0,"discounted_cash":6975.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 5X15X120CM VBHR051502A","code_information":[{"code":"Px0000458358L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10573.0,"discounted_cash":7401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9288.26,"discounted_cash":6501.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 6X10X120CM VBHR061002A","code_information":[{"code":"Px0000458365L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9965.0,"discounted_cash":6975.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 6X15X120CM","code_information":[{"code":"Px0000458367L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10408.0,"discounted_cash":7285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9288.26,"discounted_cash":6501.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9429.0,"discounted_cash":6600.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 7X15X120CM VBHR071502A","code_information":[{"code":"Px0000458376L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10999.0,"discounted_cash":7699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9288.26,"discounted_cash":6501.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 8X10X120CM VBHR081002A","code_information":[{"code":"Px0000458383L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9429.0,"discounted_cash":6600.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 8X15X120CM","code_information":[{"code":"Px0000458385L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10999.0,"discounted_cash":7699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN A 6FR 6X25X120CM VBJR062502A","code_information":[{"code":"Px0000458396L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":17347.0,"discounted_cash":12142.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 35 CUBE 6X20","code_information":[{"code":"Px0000458660L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.0,"discounted_cash":1213.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 35 CUBE 8X20","code_information":[{"code":"Px0000458661L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":1991.0,"discounted_cash":1393.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 35 CUBE 10X25","code_information":[{"code":"Px0000458662L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":1991.0,"discounted_cash":1393.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 35 CUBE 15X25 M002363810 M001363810","code_information":[{"code":"Px0000458663L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":1991.0,"discounted_cash":1393.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ACUITY X4 STR 86CM 4671","code_information":[{"code":"Px0000458689L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3191.0,"discounted_cash":2233.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ACUITY X4 SH TP SPRL 86 CM 4674","code_information":[{"code":"Px0000458691L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3191.0,"discounted_cash":2233.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ACUITY X4 LG TP SPRL 86CM 4677","code_information":[{"code":"Px0000458693L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3191.0,"discounted_cash":2233.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ACUITY X4 LG TP SPLR 95 CM 4678","code_information":[{"code":"Px0000458694L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3191.0,"discounted_cash":2233.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED TG M-KEY 16FX2.5X45","code_information":[{"code":"Px0000458933L","type":"CDM"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED TG M-KEY 18FX1.7X30 0270181730","code_information":[{"code":"Px0000458942L","type":"CDM"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED TG M-KEY 22FX3.5X45 0270223545","code_information":[{"code":"Px0000458956L","type":"CDM"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ANGIO NAVICROSS STR 90CM NC35900","code_information":[{"code":"Px0000459185L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"discounted_cash":640.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3235.0,"discounted_cash":2264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO APOLLO 1.5CM 1055095000","code_information":[{"code":"Px0000459317L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5703.0,"discounted_cash":3992.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO APOLLO 3.0CM 1055096000","code_information":[{"code":"Px0000459318L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5703.0,"discounted_cash":3992.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ASP NAVIEN 6FR 130CM STR RFX07213008","code_information":[{"code":"Px0000459329L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5490.0,"discounted_cash":3843.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE PLAT PLS 300CM M001467120","code_information":[{"code":"Px0000459334L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 6FR PRELUDE ACT 50 CM PSI6F11038ACT","code_information":[{"code":"Px0000460532L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET ACCESS INTRAHEP TRAN 10FR G29769","code_information":[{"code":"Px0000460579L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.99,"discounted_cash":1175.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EXCELSIOR XT-27 STR 150CM M003XT2750810","code_information":[{"code":"Px0000460604L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2854.0,"discounted_cash":1997.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT TREVO XP PROVUE RETREVER 3X20MM 90183","code_information":[{"code":"Px0000460630L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE TRAXCESS 14 SET .014 200CM GW1420040","code_information":[{"code":"Px0000460662L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE SOFIA 5FR STR 125CM DA5125ST","code_information":[{"code":"Px0000460675L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":2681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN DC LUTONIX.035X5X80X130 LX35130580","code_information":[{"code":"Px0000461283L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN DC LUTNIX.035X5X100X130 LX351305100","code_information":[{"code":"Px0000461286L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN DC LUTNIX.035X6X100X130 LX351306100","code_information":[{"code":"Px0000461287L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ULTVRS .035 7X40X75 U357574","code_information":[{"code":"Px0000461370L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ULTVRS .035 8X20X75 U357582","code_information":[{"code":"Px0000461388L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IAB SENS PLS 8FR 50CC 068400057601U","code_information":[{"code":"Px0000461662L","type":"CDM"}],"standard_charges":[{"gross_charge":2941.0,"discounted_cash":2058.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED CORTRAK2 36IN 8FR 209368TRAK2","code_information":[{"code":"Px0000461883L","type":"CDM"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED CORTRAK2 43IN 8FR 209438TRAK2","code_information":[{"code":"Px0000461884L","type":"CDM"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN HRT DUO ECLS PROTEK 29F","code_information":[{"code":"Px0000461926L","type":"CDM"}],"standard_charges":[{"gross_charge":21282.0,"discounted_cash":14897.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE CONVEY 5FR JL3","code_information":[{"code":"Px0000462777L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":298.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LVIS 5.5 X 27MM 214035-LVIS 214035LVIS","code_information":[{"code":"Px0000462870L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":16892.0,"discounted_cash":11824.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION STENT NON COATED LVIS JR NITINOL 2.5X3MM 172032LVISJ","code_information":[{"code":"Px0000462875L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":18374.0,"discounted_cash":12861.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .018X300CM GA1830","code_information":[{"code":"Px0000462938L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ATTAIN PERFORMA 439888","code_information":[{"code":"Px0000463004L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD ATTAIN PERFORMA 459888","code_information":[{"code":"Px0000463006L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR SGL 3 FR W/SH","code_information":[{"code":"Px0000463107L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.7,"discounted_cash":627.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KT GD TRANSSPT 45D .032INX63CM","code_information":[{"code":"Px0000463119L","type":"CDM"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":505.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE PGTL PROTRK .025INX230CM PTW25230","code_information":[{"code":"Px0000463120L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH ATHRECTOMY COR 1.25MMX135CM DBEC125","code_information":[{"code":"Px0000463708L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":10849.0,"discounted_cash":7594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SOLITAIRE2 FR REVASC 4X40 SFR2440","code_information":[{"code":"Px0000463735L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":19378.0,"discounted_cash":13564.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE CLSR VASC MYNXGRIP 5FR MX5021","code_information":[{"code":"Px0000463810L","type":"CDM"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PWR SL 3FR","code_information":[{"code":"Px0000463826L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.28,"discounted_cash":362.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X40MMX130CM ADM04004013P","code_information":[{"code":"Px0000465009L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X60MMX130CM ADM04006013P","code_information":[{"code":"Px0000465011L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X80MMX130CM ADM04008013P","code_information":[{"code":"Px0000465013L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X80MMX80CM","code_information":[{"code":"Px0000465014L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X120MMX130CM ADM04012013P","code_information":[{"code":"Px0000465015L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X120MMX80CM","code_information":[{"code":"Px0000465016L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X40MMX130CM ADM05004013P","code_information":[{"code":"Px0000465017L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X40MMX80CM","code_information":[{"code":"Px0000465018L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X60MMX130CM ADM05006013P","code_information":[{"code":"Px0000465019L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X80MMX130CM ADM05008013P","code_information":[{"code":"Px0000465021L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X80MMX80CM","code_information":[{"code":"Px0000465022L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X120MMX130CM ADM05012013P","code_information":[{"code":"Px0000465023L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X40MMX130CM ADM06004013P","code_information":[{"code":"Px0000465025L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X40MMX80CM","code_information":[{"code":"Px0000465026L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X60MMX130CM ADM06006013P","code_information":[{"code":"Px0000465027L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X60MMX80CM","code_information":[{"code":"Px0000465028L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X80MMX130CM ADM06008013P","code_information":[{"code":"Px0000465029L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X80MMX80CM","code_information":[{"code":"Px0000465030L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X120MMX130CM ADM06012013P","code_information":[{"code":"Px0000465031L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X40MMX130CM ADM07004013P","code_information":[{"code":"Px0000465033L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X40MMX80CM","code_information":[{"code":"Px0000465034L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X60MMX130CM ADM07006013P","code_information":[{"code":"Px0000465035L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X60MMX80CM","code_information":[{"code":"Px0000465036L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X80MMX130CM ADM07008013P","code_information":[{"code":"Px0000465037L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMART ABLATE TUBING SAT001","code_information":[{"code":"Px0000465560L","type":"CDM"}],"standard_charges":[{"gross_charge":459.36,"discounted_cash":321.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D DYNAGEN DF4","code_information":[{"code":"Px0000484778L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":47554.0,"discounted_cash":33287.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-P VALITUDE X4 QUAD U128","code_information":[{"code":"Px0000484782L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":11068.0,"discounted_cash":7747.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT URO BNDR 6FR 75CM","code_information":[{"code":"Px0000510994L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO HDWY ADV 17 STR MC172150SX","code_information":[{"code":"Px0000511180L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2439.77,"discounted_cash":1707.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRNAGE PERI COMPLT 4992207","code_information":[{"code":"Px0000511363L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":2713.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PERIPH DIL CHARGER 10X4X75 3920610047","code_information":[{"code":"Px0000511595L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 12X4X13","code_information":[{"code":"Px0000511596L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 12X4X75 3920612047","code_information":[{"code":"Px0000511597L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X40X13 H74939206040410","code_information":[{"code":"Px0000511600L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X4X75 3920604047","code_information":[{"code":"Px0000511601L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 5X100X1 H74939206051010","code_information":[{"code":"Px0000511602L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 5X150X1 H74939206051510","code_information":[{"code":"Px0000511603L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 5X2X75 3920605027","code_information":[{"code":"Px0000511605L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 5X4X135 H74939206050410","code_information":[{"code":"Px0000511606L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 5X4X75 3920605047","code_information":[{"code":"Px0000511607L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 6X40X13 3920606041","code_information":[{"code":"Px0000511612L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 6X4X75 3920606047","code_information":[{"code":"Px0000511613L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 7X100X1","code_information":[{"code":"Px0000511614L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PERIPH DIL CHARGER 7X2X75 3920607027","code_information":[{"code":"Px0000511616L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 7X40X13 3920607041","code_information":[{"code":"Px0000511617L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 7X4X75 3920607047","code_information":[{"code":"Px0000511618L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 8X2X75 3920608027","code_information":[{"code":"Px0000511620L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 8X40X13 3920608041","code_information":[{"code":"Px0000511621L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 8X4X75 3920608047","code_information":[{"code":"Px0000511622L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 9X4X75 3920609047","code_information":[{"code":"Px0000511624L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER10X40X13 3920610041","code_information":[{"code":"Px0000511626L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN STRLG OTW 5X200X135 H74939206052010","code_information":[{"code":"Px0000511631L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP 7LUM W/SVO2 8FRX110CM","code_information":[{"code":"Px0000512653L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1325.0,"discounted_cash":927.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH STEER CRV 55CM 7MM DST0655507D2","code_information":[{"code":"Px0000513242L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3008.97,"discounted_cash":2106.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET LIVER BIOP TRNSJUG ACC TL18C","code_information":[{"code":"Px0000514207L","type":"CDM"}],"standard_charges":[{"gross_charge":1725.96,"discounted_cash":1208.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH GDE RADPQ 16F 45CM EA 1 EA G28445","code_information":[{"code":"Px0000514955L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":352.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 150CM ANGLED","code_information":[{"code":"Px0000515889L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INST RETRV TREVO PROVUE 6X25 90186","code_information":[{"code":"Px0000516114L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RETVR TRVO PROVUE 6X25PLS XT27 93068","code_information":[{"code":"Px0000516115L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15819.0,"discounted_cash":11073.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE 2 LNG 9FR 23CM","code_information":[{"code":"Px0000532263L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.2,"discounted_cash":634.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE ASAHI GAIA .26 190 MIC J AHW14R007P","code_information":[{"code":"Px0000536188L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-P VALITUDE NON QUAD U125","code_information":[{"code":"Px0000536411L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":10367.0,"discounted_cash":7256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D IDC-18 SOFT 3MMX10CM M0013613100","code_information":[{"code":"Px0000536461L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.0,"discounted_cash":1054.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D IDC-18 SOFT 4MMX8CM M0013614080","code_information":[{"code":"Px0000536463L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.0,"discounted_cash":1054.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL 2D IDC-18 SOFT 4MMX12CM M0013614120","code_information":[{"code":"Px0000536464L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.0,"discounted_cash":1054.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 4MM RBYPOD4","code_information":[{"code":"Px0000543983L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5860.0,"discounted_cash":4102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 5MM RBYPOD5","code_information":[{"code":"Px0000543984L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5860.0,"discounted_cash":4102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 6MM RBYPOD6","code_information":[{"code":"Px0000543985L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5377.0,"discounted_cash":3763.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 8MM RBYPOD8","code_information":[{"code":"Px0000543986L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5377.0,"discounted_cash":3763.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE CHIKAI BLK 0.46MM200CM WAINCKI18200BS","code_information":[{"code":"Px0000544068L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET GI ENTUIT PLACEMENT MED G34443","code_information":[{"code":"Px0000546447L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TURNPIKE SPIRAL 135CM 5640","code_information":[{"code":"Px0000546482L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2055.0,"discounted_cash":1438.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TURNPIKE HARD GOLD 135 CM 5621","code_information":[{"code":"Px0000546483L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2261.0,"discounted_cash":1582.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SUPERCROSS 90D ANG 150CM 5305","code_information":[{"code":"Px0000546486L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":1195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCC LDR MICRO PLUG MECH MVP MVP5Q","code_information":[{"code":"Px0000546494L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ENPROS WSTNT OTW 24X75 H965405120","code_information":[{"code":"Px0000546687L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1LS","code_information":[{"code":"Px0000546902L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":10028.0,"discounted_cash":7019.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1LX","code_information":[{"code":"Px0000546903L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9178.0,"discounted_cash":6424.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE TFE .035 260 EXT ST G23640","code_information":[{"code":"Px0000546987L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN FEM ARTERIAL 23F 96540023","code_information":[{"code":"Px0000547028L","type":"CDM"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SOUNDSTAR ECO 8FR 10439011","code_information":[{"code":"Px0000547064L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":7490.0,"discounted_cash":5243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHR ONCOZENE 75 2ML 0603010075202","code_information":[{"code":"Px0000547097L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4959.0,"discounted_cash":3471.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT VALVE HEART THV SAPIEN3 23MM 9600CM23A","code_information":[{"code":"Px0000547424L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":69550.0,"discounted_cash":48685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT HRT VLV TAVR SAPIEN 3 26MM 9600CM26A","code_information":[{"code":"Px0000547425L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":69550.0,"discounted_cash":48685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT HRT VLV TAVR SAPIEN 3 29MM 9600CM29A","code_information":[{"code":"Px0000547426L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":69550.0,"discounted_cash":48685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FORTREX 6F 4X40X 80CM","code_information":[{"code":"Px0000547455L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FORTREX 6F 4X100X135CM","code_information":[{"code":"Px0000547462L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FORTREX 6F 8X40X80CM A35HPV08040080","code_information":[{"code":"Px0000547500L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FORTREX 7F 9X40X 80CM A35HPV09040080","code_information":[{"code":"Px0000547510L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOCROSS EL 5X40 150 CM AB14W050040150","code_information":[{"code":"Px0000547530L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 5X80MMX150CM","code_information":[{"code":"Px0000547534L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 5X150MMX150CM","code_information":[{"code":"Px0000547540L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOCROSS EL 6X40 150 CM AB14W060040150","code_information":[{"code":"Px0000547546L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NANOX 6X80MMX150CM AB14W060080150","code_information":[{"code":"Px0000547550L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 5X35 PED50035","code_information":[{"code":"Px0000547783L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":37087.0,"discounted_cash":25960.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 2.5X10 PED25010","code_information":[{"code":"Px0000547784L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 3X14","code_information":[{"code":"Px0000547798L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 4.0X16 PED40016","code_information":[{"code":"Px0000547823L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 4.25X12 PED42512","code_information":[{"code":"Px0000547827L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 4.5X14 PED45014","code_information":[{"code":"Px0000547834L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 4.5X16 PED45016","code_information":[{"code":"Px0000547835L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 4.75X14 PED47514","code_information":[{"code":"Px0000547840L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 5.00X20 PED50020","code_information":[{"code":"Px0000547849L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34516.0,"discounted_cash":24161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLUDER SEPTL CARDIOFORM 25MM GSX0025A","code_information":[{"code":"Px0000547960L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":20259.0,"discounted_cash":14181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS 5 MAX ACE 64 5MAXACE064","code_information":[{"code":"Px0000574795L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7723.0,"discounted_cash":5406.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT BNCHMK ST 95 W 5F BER 120 BMK6F95BER120","code_information":[{"code":"Px0000574796L","type":"CDM"}],"standard_charges":[{"gross_charge":3046.0,"discounted_cash":2132.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT BNCHMK MP 95 W 5F BER 120 BMK6F95MBER120","code_information":[{"code":"Px0000574797L","type":"CDM"}],"standard_charges":[{"gross_charge":3259.0,"discounted_cash":2281.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT BNCHMK ST 105 W 5F BER 130 BMK6F105BER130","code_information":[{"code":"Px0000574798L","type":"CDM"}],"standard_charges":[{"gross_charge":3259.0,"discounted_cash":2281.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT BNCHMK MP 105 W 5F BER 130 BMK6F105MBER130","code_information":[{"code":"Px0000574799L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3259.0,"discounted_cash":2281.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BENCHMARK STR 95CM BMK6F95","code_information":[{"code":"Px0000574800L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3259.0,"discounted_cash":2281.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BENCHMARK MP 95CM BMK6F95M","code_information":[{"code":"Px0000574801L","type":"CDM"}],"standard_charges":[{"gross_charge":3259.0,"discounted_cash":2281.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BENCHMARK STR  105CM BMK6F105","code_information":[{"code":"Px0000574802L","type":"CDM"}],"standard_charges":[{"gross_charge":3259.0,"discounted_cash":2281.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BENCHMARK MP  105CM","code_information":[{"code":"Px0000574803L","type":"CDM"}],"standard_charges":[{"gross_charge":3259.0,"discounted_cash":2281.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER 6 STRAIGHT TIP 135CM CAT6","code_information":[{"code":"Px0000575589L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6188.0,"discounted_cash":4331.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEPARATOR WIRE 6 SEP6 SEP6","code_information":[{"code":"Px0000575590L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.0,"discounted_cash":2548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEPARATOR WIRE 8 SEP8 SEP8","code_information":[{"code":"Px0000575594L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5508.0,"discounted_cash":3855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBING LARGER BORE ASPIRATION IST3","code_information":[{"code":"Px0000575595L","type":"CDM"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":1128.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 7FR IBI XXL 81202-REP","code_information":[{"code":"Px0000590584L","type":"CDM"}],"standard_charges":[{"gross_charge":1977.0,"discounted_cash":1383.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 1110-6-5-M-TE2BE2-BD-REP","code_information":[{"code":"Px0000590585L","type":"CDM"}],"standard_charges":[{"gross_charge":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 8FR 90CM DF CRV-REP","code_information":[{"code":"Px0000590934L","type":"CDM"}],"standard_charges":[{"gross_charge":1040.69,"discounted_cash":728.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 8FR 90CM FJ CRV-REP","code_information":[{"code":"Px0000590935L","type":"CDM"}],"standard_charges":[{"gross_charge":1040.69,"discounted_cash":728.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD DR EVERA XT MRI DDMB1D4","code_information":[{"code":"Px0000590989L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18489.0,"discounted_cash":12942.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLUDER SEPTL CARDIOFORM 30MM GSX0030A","code_information":[{"code":"Px0000591007L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":20259.0,"discounted_cash":14181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL TRANSEPT 71CM 8.0F CRV C1 NRGEHF71C1","code_information":[{"code":"Px0000591140L","type":"CDM"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":1192.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14FX1.2CMX22CM","code_information":[{"code":"Px0000591230L","type":"CDM"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14FX1.7CMX22CM","code_information":[{"code":"Px0000591234L","type":"CDM"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14FX1.7CMX30CM","code_information":[{"code":"Px0000591235L","type":"CDM"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14FX2.0CMX30CM","code_information":[{"code":"Px0000591238L","type":"CDM"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDESHEATH SLNDR SS 5F 10CM 801050","code_information":[{"code":"Px0000591378L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.4,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDESHEATH SLNDR SS 7FR 10CM 801070","code_information":[{"code":"Px0000591380L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14FX1.5CMX30CM","code_information":[{"code":"Px0000591406L","type":"CDM"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE JEJU G-JET 14FX3.5CMX45CM","code_information":[{"code":"Px0000591408L","type":"CDM"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CUFF SL PWR 6FX60CM","code_information":[{"code":"Px0000591410L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CUFF DL PWR 6FRX60CM","code_information":[{"code":"Px0000591411L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE HYDRPHLC SS .010INX80CM","code_information":[{"code":"Px0000591413L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TURNPIKE SPIRAL 150 CM 5641","code_information":[{"code":"Px0000591645L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2274.0,"discounted_cash":1591.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYSTEM SUREFIRE PRECIS INFUS","code_information":[{"code":"Px0000591715L","type":"CDM"},{"code":"C1982","type":"HCPCS"}],"standard_charges":[{"gross_charge":20437.53,"discounted_cash":14306.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI SUPERA 5X80X120 S50080120P6","code_information":[{"code":"Px0000591866L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI SUPERA 5X120X120 S50120120P6","code_information":[{"code":"Px0000591868L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4264.0,"discounted_cash":2984.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC MARKSMAN 160CM FA551601030","code_information":[{"code":"Px0000591894L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PEG ABBVIE 15FR 629100116","code_information":[{"code":"Px0000592789L","type":"CDM"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE J ABBVIE 9FR 629180116","code_information":[{"code":"Px0000592790L","type":"CDM"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LOOP RECORDER LINQ SYS LINQSYS","code_information":[{"code":"Px0000593101L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":11362.76,"discounted_cash":7953.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER PULMONARY ARTERY W/PACER D200F7","code_information":[{"code":"Px0000593210L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":1138.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 4X13 45780413","code_information":[{"code":"Px0000593897L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.64,"discounted_cash":2107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 5X16 45780516","code_information":[{"code":"Px0000593898L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.64,"discounted_cash":2107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 6X20 45780620","code_information":[{"code":"Px0000593899L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 7X24 45780724","code_information":[{"code":"Px0000593900L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 8X28 45780828","code_information":[{"code":"Px0000593901L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.3,"discounted_cash":2105.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR10X32 45781032","code_information":[{"code":"Px0000593903L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.3,"discounted_cash":2105.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO PERFORMER .038 14FRX45CM G28438","code_information":[{"code":"Px0000594373L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PRELUDE W/NDL 6 FR PSI6F23018NT4","code_information":[{"code":"Px0000594556L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 5FR DECA MED CURVE -REP","code_information":[{"code":"Px0000595340L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 4FR DECA MED CURVE-REP","code_information":[{"code":"Px0000595341L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":625.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 6 FR INQ STEER QUAD-REP","code_information":[{"code":"Px0000595358L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SUPREME DECAPLR 5FR -REP 401863RH","code_information":[{"code":"Px0000595362L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SNDSTAR ECO SMS 10FR-REP 10438577RH","code_information":[{"code":"Px0000595389L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":4187.0,"discounted_cash":2930.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO LANTERN STR 135CM PXSLIMLAN135STR","code_information":[{"code":"Px0000595721L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2046.0,"discounted_cash":1432.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 15 RBYPODJ15","code_information":[{"code":"Px0000595727L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 30 RBYPODJ30","code_information":[{"code":"Px0000595728L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 45 RBYPODJ45","code_information":[{"code":"Px0000595729L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 60 RBYPODJ60","code_information":[{"code":"Px0000595730L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SCORING OTW PTA 7X40X90 23337040","code_information":[{"code":"Px0000595772L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3994.0,"discounted_cash":2795.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SCORING OTW PTA 8X40X90 23338040","code_information":[{"code":"Px0000595774L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3994.0,"discounted_cash":2795.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RE-ENTRY OUTBCK ELT 120CM OTB59120A","code_information":[{"code":"Px0000595776L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7156.0,"discounted_cash":5009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RE-ENTRY OUTBCK ELT 80CM","code_information":[{"code":"Px0000595850L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7156.0,"discounted_cash":5009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 1.5X2 APB1523DES","code_information":[{"code":"Px0000596046L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 2X2 APB223DES","code_information":[{"code":"Px0000596049L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 2X3 APB233DES","code_information":[{"code":"Px0000596050L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 2X4 APB243DES","code_information":[{"code":"Px0000596051L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 3X4 APB343DES","code_information":[{"code":"Px0000596054L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 3X6 APB363DES","code_information":[{"code":"Px0000596055L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 3X8 APB383DES","code_information":[{"code":"Px0000596056L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 3.5X6 APB3563DES","code_information":[{"code":"Px0000596057L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 3.5X10 APB35103DES","code_information":[{"code":"Px0000596059L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES HX 1X2 APB12HXES","code_information":[{"code":"Px0000596061L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3725.0,"discounted_cash":2607.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES HX 1.5X4 APB154HXES","code_information":[{"code":"Px0000596066L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3725.0,"discounted_cash":2607.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TURNPIKE LO-PRO 150CM 5639","code_information":[{"code":"Px0000596127L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2243.0,"discounted_cash":1570.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE GLADIUS 200 CM PPW14R100S","code_information":[{"code":"Px0000600750L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":637.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THROMB ZELANTE DVT 114610001","code_information":[{"code":"Px0000602291L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9464.95,"discounted_cash":6625.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE ORB ATHE SOLID 1.25 145 DBP125SOLID145","code_information":[{"code":"Px0000602299L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":9521.0,"discounted_cash":6664.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE ORB ATHE SOLID 1.5 145 DBP150SOLID145","code_information":[{"code":"Px0000602302L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":9521.0,"discounted_cash":6664.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ZILVER S PTX 6X40MM G38463","code_information":[{"code":"Px0000604353L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2703.0,"discounted_cash":1892.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ZILVER S P TX 6X80MM G38480","code_information":[{"code":"Px0000604355L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ZILVER S P TX 6X100MM G38481","code_information":[{"code":"Px0000604356L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3957.0,"discounted_cash":2769.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT ZILVER S PTX 6X120MM 125CM G38482","code_information":[{"code":"Px0000604357L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4397.0,"discounted_cash":3077.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT TBNG CATH THRMB ACE64 5MAXACE064KIT","code_information":[{"code":"Px0000607468L","type":"CDM"}],"standard_charges":[{"gross_charge":8567.0,"discounted_cash":5996.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TRGD 6.5F 55CM 9MMDEF TG0655509","code_information":[{"code":"Px0000607522L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2107.75,"discounted_cash":1475.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TRGD 8.5F 55CM 17MMDEF TG0855517","code_information":[{"code":"Px0000607529L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1925.0,"discounted_cash":1347.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR MICRO PLUG MECH MVP 7MM MVP7Q","code_information":[{"code":"Px0000607739L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLDR MICRO PLUG MECH MVP 9MM MVP9Q","code_information":[{"code":"Px0000607740L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6532.0,"discounted_cash":4572.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PWR TIP 3CG 4F DL 55CM 1274108","code_information":[{"code":"Px0000607792L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DAC AXS CATLYST 5 115CM M003IC0581150","code_information":[{"code":"Px0000607855L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5129.0,"discounted_cash":3590.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DAC AXS CATLYST 6 132CM M003IC0601320","code_information":[{"code":"Px0000607857L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6880.0,"discounted_cash":4816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RETRV TREVO XP PROVUE 4X20","code_information":[{"code":"Px0000607858L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN FLOWGATE2 BGC 8FR 85CM 90485","code_information":[{"code":"Px0000607859L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3074.0,"discounted_cash":2151.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET XL 360 SFT 3X6 M0036123060","code_information":[{"code":"Px0000607863L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":4130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET XL 360 SFT 4X8 M0036124080","code_information":[{"code":"Px0000607865L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":4130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET XL 360 SFT 5X15 M0036125150","code_information":[{"code":"Px0000607868L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":4130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MHRKR 12 FR STR 4MMX13CM 8888221113","code_information":[{"code":"Px0000608263L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH MHRKR 12 FR 4MMX16CM 8888221216","code_information":[{"code":"Px0000608265L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 3.0X12 H7493926012300","code_information":[{"code":"Px0000608795L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 3.0X20 H7493926020300","code_information":[{"code":"Px0000608797L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 3.0X32 H7493926032300","code_information":[{"code":"Px0000608800L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 4.0X38 H7493926038400","code_information":[{"code":"Px0000608817L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIDESHEATH SS-KT .021 6F 25CM 202560","code_information":[{"code":"Px0000609031L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR10X19 45751019","code_information":[{"code":"Px0000610468L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR13X24 45751324","code_information":[{"code":"Px0000610469L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 5X11 45750511","code_information":[{"code":"Px0000610470L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 6X17 45750617","code_information":[{"code":"Px0000610471L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 6X9 45750609","code_information":[{"code":"Px0000610472L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 8X24 45750824","code_information":[{"code":"Px0000610473L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE PRESS COMET 185CM H7495551110","code_information":[{"code":"Px0000610506L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2207.0,"discounted_cash":1544.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CARAVEL MIC 1.9 FR 150 CM CRV150-19P CRV15019P","code_information":[{"code":"Px0000610795L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIAG BRNSTN 4FR 65X25CM","code_information":[{"code":"Px0000610994L","type":"CDM"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT PRBE OSTEOCOOL RF17G 7MM OCP207","code_information":[{"code":"Px0000611246L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":6080.0,"discounted_cash":4256.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT PRBE OSTEOCOOL RF17G 10MM OCP210","code_information":[{"code":"Px0000611247L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":6080.0,"discounted_cash":4256.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5523.0,"discounted_cash":3866.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACEMAKER ACCOLADE DR MRI L311","code_information":[{"code":"Px0000611410L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":5523.0,"discounted_cash":3866.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACEMAKER ACCOLADE VR MRI L310","code_information":[{"code":"Px0000611411L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":4599.0,"discounted_cash":3219.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD VISIA SR AF MRI SURESCAN DVFB1D4","code_information":[{"code":"Px0000611432L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15326.0,"discounted_cash":10728.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 4X20","code_information":[{"code":"Px0000612095L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 4X40 SFR344010","code_information":[{"code":"Px0000612096L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 6X20","code_information":[{"code":"Px0000612097L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 6X40 SFR364010","code_information":[{"code":"Px0000612098L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15536.0,"discounted_cash":10875.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC PHENOM 27 0615 CONFIG FG1515006151S","code_information":[{"code":"Px0000612103L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3647.0,"discounted_cash":2552.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO PHENOM PLUS 120CM FG1912010301S","code_information":[{"code":"Px0000612106L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4623.0,"discounted_cash":3236.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET BIOPSY LIVER ACCESS G50779","code_information":[{"code":"Px0000612523L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D QUADRA ASSURA MP 40 CD336940C","code_information":[{"code":"Px0000615014L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24266.0,"discounted_cash":16986.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONN CRT-D QUADRA ASSURA 40 DF CD336940Q","code_information":[{"code":"Px0000615015L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":27331.0,"discounted_cash":19131.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD LV QUARTET SM 86CM 1456Q86","code_information":[{"code":"Px0000615018L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD LV QUARTET WD SPC 86CM 1458QL86","code_information":[{"code":"Px0000615020L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP SUPR 4F QUAD CRD 401891","code_information":[{"code":"Px0000615257L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DECA MED 5F CVD","code_information":[{"code":"Px0000615258L","type":"CDM"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":1313.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL SMART SFT 5MMX10CM 400SMTSFT0510","code_information":[{"code":"Px0000615542L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5621.0,"discounted_cash":3934.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL SMART HELIX XSOFT 1X2 CM 400SMTHXSFT0102","code_information":[{"code":"Px0000615577L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3809.0,"discounted_cash":2666.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL SMART HELIX XSOFT 2X4 CM 400SMTHXSFT0204","code_information":[{"code":"Px0000615584L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3809.0,"discounted_cash":2666.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL SMART HELIX XSOFT 3X6 CM 400SMTHXSFT0306","code_information":[{"code":"Px0000615589L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3809.0,"discounted_cash":2666.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HANDLE DETCHMNT SMART COIL SCH1","code_information":[{"code":"Px0000615594L","type":"CDM"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":766.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD CRT-D LV QUARTET 86MM 1457Q86","code_information":[{"code":"Px0000615994L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH DEST TUOHY VLV 8FR 45CM 5484506","code_information":[{"code":"Px0000616119L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH DRYSEAL GORE 12F 45CM DSF1245","code_information":[{"code":"Px0000619929L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.0,"discounted_cash":959.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN BIOMEDICUS 17FR 96570117","code_information":[{"code":"Px0000620887L","type":"CDM"}],"standard_charges":[{"gross_charge":1274.0,"discounted_cash":891.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SLCT 6F 125H1","code_information":[{"code":"Px0000621039L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIK 5FR .38 80CM 58038MIK","code_information":[{"code":"Px0000621061L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 4.00X8MM H7493926708400","code_information":[{"code":"Px0000622347L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 5.50X8MM H7493926708550","code_information":[{"code":"Px0000622350L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 2.00X15MM H7493926715200","code_information":[{"code":"Px0000622365L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE RUNTHRU HYPERCT NS 253011","code_information":[{"code":"Px0000622693L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 4X100 LX3513041005F","code_information":[{"code":"Px0000622711L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 4X120 EA LX3513041205F","code_information":[{"code":"Px0000622712L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 4X60 LX351304605F","code_information":[{"code":"Px0000622715L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 4X80 LX351304805F","code_information":[{"code":"Px0000622716L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 5X100 LX3513051005F","code_information":[{"code":"Px0000622717L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 5X120 LX3513051205F","code_information":[{"code":"Px0000622718L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3383.01,"discounted_cash":2368.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 5X40 LX351305405F","code_information":[{"code":"Px0000622720L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130 CM 5X60 EA 1 EA LX351305605F","code_information":[{"code":"Px0000622721L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 5X80 LX351305805F","code_information":[{"code":"Px0000622722L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 6X100 LX3513061005F","code_information":[{"code":"Px0000622723L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 6X120 LX3513061205F","code_information":[{"code":"Px0000622724L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 6X150 LX3513061505F","code_information":[{"code":"Px0000622725L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4959.0,"discounted_cash":3471.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 6X40 LX351306405F","code_information":[{"code":"Px0000622726L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 6X60 LX351306605F","code_information":[{"code":"Px0000622727L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN LTNX .035 130CM 6X80 LX351306805F","code_information":[{"code":"Px0000622728L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3383.01,"discounted_cash":2368.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC PEDS DUAL 4FX135CM","code_information":[{"code":"Px0000623139L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.04,"discounted_cash":378.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DLYS SPLITCATH 10FR 15CM","code_information":[{"code":"Px0000623300L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":866.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HEMODIA LT STR 12.5F 15CM MC101241","code_information":[{"code":"Px0000623683L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":660.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HEMODIA STR LT 12.5F 18CM","code_information":[{"code":"Px0000623684L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":660.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PICC PROV 5FR NIT 135 CM GW","code_information":[{"code":"Px0000623693L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.43,"discounted_cash":533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD SUB Q EMB MRI PULSE GEN A219 A219","code_information":[{"code":"Px0000623719L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":40306.0,"discounted_cash":28214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 12F 33CM DSF1233","code_information":[{"code":"Px0000637127L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":814.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 16FR 33CM DSF1633","code_information":[{"code":"Px0000637130L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.33,"discounted_cash":965.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 18FR 33CM DSF1833","code_information":[{"code":"Px0000637131L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.0,"discounted_cash":1032.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 20FR 33CM DSF2033","code_information":[{"code":"Px0000637132L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.81,"discounted_cash":1223.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 22FR 33CM DSF2233","code_information":[{"code":"Px0000637134L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.0,"discounted_cash":1032.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 24FR 33CM DSF2433","code_information":[{"code":"Px0000637136L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"discounted_cash":1029.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 26FR 33CM DSF2633","code_information":[{"code":"Px0000637138L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1578.0,"discounted_cash":1104.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD VISIA AR MRI DF 1 DVFB1D1 DVFB1D1","code_information":[{"code":"Px0000637321L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15326.0,"discounted_cash":10728.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD EVERA MRI XT DR DF1 DDMB1D1","code_information":[{"code":"Px0000637322L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18489.0,"discounted_cash":12942.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN CONQ40 12X40MMX75CM","code_information":[{"code":"Px0000637332L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ATLAS 12FR 14X40MMX120CM","code_information":[{"code":"Px0000637333L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":978.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH THRMB W/TBNG ACE68 5MAXACE068KIT","code_information":[{"code":"Px0000637727L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8567.0,"discounted_cash":5996.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PACIFIC PLS 6X40MMX130CM PCP060040130","code_information":[{"code":"Px0000637997L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN PACIFIC PLS 6X60MMX130CM PCP060060130","code_information":[{"code":"Px0000637998L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":355.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI WFLX RX 8.5FR 8X80 M00570350","code_information":[{"code":"Px0000638022L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5928.0,"discounted_cash":4149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN ART FEM B-MDCUS CARM 8FR","code_information":[{"code":"Px0000638463L","type":"CDM"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":800.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LIGASURE IMPACT 36MM-18CM LF4418","code_information":[{"code":"Px0000638812L","type":"CDM"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 7F CRV 110CM W/4MM TIP M IBI83365","code_information":[{"code":"Px0000639399L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":1677.0,"discounted_cash":1173.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT FX STABILIT PWR CRV","code_information":[{"code":"Px0000640549L","type":"CDM"}],"standard_charges":[{"gross_charge":8579.0,"discounted_cash":6005.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC ASAHI CORSAIR PRO 135CM CSR13526P","code_information":[{"code":"Px0000643004L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1942.0,"discounted_cash":1359.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CV POLY MDL SGL 4FR FULL","code_information":[{"code":"Px0000643195L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.53,"discounted_cash":416.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X150MMX130CM ADM04015013P","code_information":[{"code":"Px0000643204L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3900.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X150MMX130CM ADM05015013P","code_information":[{"code":"Px0000643205L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3900.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X150MMX130CM ADM06015013P","code_information":[{"code":"Px0000643206L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3900.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN ZMED2 9FR 26X40MMX100CM 611659","code_information":[{"code":"Px0000643283L","type":"CDM"}],"standard_charges":[{"gross_charge":2506.0,"discounted_cash":1754.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1M","code_information":[{"code":"Px0000643290L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9178.0,"discounted_cash":6424.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1S","code_information":[{"code":"Px0000643291L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9178.0,"discounted_cash":6424.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TRAILBLAZER .014X150CM ASC014150","code_information":[{"code":"Px0000643294L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.82,"discounted_cash":538.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TRAILBLAZER .035X135CM ASC035135","code_information":[{"code":"Px0000643300L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.82,"discounted_cash":538.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PATCH ENSITE PRECIS NAVX SE EN0020P","code_information":[{"code":"Px0000643313L","type":"CDM"}],"standard_charges":[{"gross_charge":3655.96,"discounted_cash":2559.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5527.0,"discounted_cash":3868.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4600.0,"discounted_cash":3220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 46CM LPA1200M46","code_information":[{"code":"Px0000643579L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 52CM LPA1200M52","code_information":[{"code":"Px0000643580L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 58CM LPA1200M58","code_information":[{"code":"Px0000643581L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSPHR EMBOZENE 900 2ML PUR 19020S1","code_information":[{"code":"Px0000643708L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOBILE POWER UNIT HEARTMATE","code_information":[{"code":"Px0000644031L","type":"CDM"},{"code":"Q0479","type":"HCPCS"}],"standard_charges":[{"gross_charge":22785.0,"discounted_cash":15949.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TURB POW OTW 2.0X125MM 420050","code_information":[{"code":"Px0000645916L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":9521.0,"discounted_cash":6664.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KT 2ND FX STABILIT PWR CRV LNG","code_information":[{"code":"Px0000646029L","type":"CDM"}],"standard_charges":[{"gross_charge":5099.0,"discounted_cash":3569.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KT TUMOR ABL 5/10 PWR CRV LNG","code_information":[{"code":"Px0000646030L","type":"CDM"}],"standard_charges":[{"gross_charge":10010.0,"discounted_cash":7007.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KT TUMOR ABL 10/15 PWR CRV LNG","code_information":[{"code":"Px0000646031L","type":"CDM"}],"standard_charges":[{"gross_charge":10010.0,"discounted_cash":7007.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INST SPNSTAR ABL 5/10 G2 LNG STR-0510L","code_information":[{"code":"Px0000646032L","type":"CDM"}],"standard_charges":[{"gross_charge":8654.0,"discounted_cash":6057.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HC INST SPNSTAR ABL 10/15 G2 LNG","code_information":[{"code":"Px0000646033L","type":"CDM"}],"standard_charges":[{"gross_charge":8654.0,"discounted_cash":6057.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH TRAPLINAR 6F 5566","code_information":[{"code":"Px0000646189L","type":"CDM"}],"standard_charges":[{"gross_charge":2207.0,"discounted_cash":1544.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN DIL CONQ 8MMX6X75CM","code_information":[{"code":"Px0000646540L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN DIL CONQ 5MMX2X75CM","code_information":[{"code":"Px0000646541L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 6X15X135CM BXA061502A","code_information":[{"code":"Px0000646874L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7688.0,"discounted_cash":5381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 6X19X135CM BXA061902A","code_information":[{"code":"Px0000646880L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8065.0,"discounted_cash":5645.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 7X29X135CM BXA072902A","code_information":[{"code":"Px0000646888L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9273.0,"discounted_cash":6491.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 11X29X135CM BXA112902A","code_information":[{"code":"Px0000646896L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9156.0,"discounted_cash":6409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 8X29X135CM BXAL082902A","code_information":[{"code":"Px0000646898L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9156.0,"discounted_cash":6409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 7X39X135CM BXA073902A","code_information":[{"code":"Px0000646904L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8666.0,"discounted_cash":6066.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 8X39X135CM BXA083902A","code_information":[{"code":"Px0000646906L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9273.0,"discounted_cash":6491.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 10X39X135CM BXA103902A","code_information":[{"code":"Px0000646910L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9273.0,"discounted_cash":6491.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 11X39X135CM BXA113902A","code_information":[{"code":"Px0000646912L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9156.0,"discounted_cash":6409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 8X39X135CM BXAL083902A","code_information":[{"code":"Px0000646914L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9156.0,"discounted_cash":6409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 8X59X135CM BXA085902A","code_information":[{"code":"Px0000646922L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8861.0,"discounted_cash":6202.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 10X59X135CM BXA105902A","code_information":[{"code":"Px0000646926L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8666.0,"discounted_cash":6066.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 11X59X135CM BXA115902A","code_information":[{"code":"Px0000646928L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9156.0,"discounted_cash":6409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 8X59X135CM BXAL085902A","code_information":[{"code":"Px0000646930L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9156.0,"discounted_cash":6409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 8X79X135CM BXA087902A","code_information":[{"code":"Px0000646938L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9917.0,"discounted_cash":6941.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 11X79X80CM BXA117901A","code_information":[{"code":"Px0000646943L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10277.0,"discounted_cash":7193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 11X79X135CM BXA117902A","code_information":[{"code":"Px0000646944L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10277.0,"discounted_cash":7193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VIABAHN VBX 8X79X135CM BXAL087902A","code_information":[{"code":"Px0000646946L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10277.0,"discounted_cash":7193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE SOFIA 6FR STR 115CM DA6115ST","code_information":[{"code":"Px0000646988L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6108.0,"discounted_cash":4275.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROCATHETER REG 27 ID MC272156S","code_information":[{"code":"Px0000646992L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3011.0,"discounted_cash":2107.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THRMCL SF UNIDIR CRV D D134701","code_information":[{"code":"Px0000647102L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":10282.02,"discounted_cash":7197.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THRMCL SF UNIDIR CRV F D134702","code_information":[{"code":"Px0000647103L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":10282.02,"discounted_cash":7197.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THRMCL SF BI-DIR CRV F-J D134804","code_information":[{"code":"Px0000647108L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":9953.0,"discounted_cash":6967.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THRMCL SF BI-DIR CRV D-F D134805","code_information":[{"code":"Px0000647109L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":9953.0,"discounted_cash":6967.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1439.0,"discounted_cash":1007.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 2X2 45780202","code_information":[{"code":"Px0000648527L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.64,"discounted_cash":2107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 2X4 45780204","code_information":[{"code":"Px0000648528L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.64,"discounted_cash":2107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 3X4 45780304","code_information":[{"code":"Px0000648529L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.64,"discounted_cash":2107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 3X8 45780308","code_information":[{"code":"Px0000648530L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.64,"discounted_cash":2107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MICRO NINJA 2.9/2.4F 125","code_information":[{"code":"Px0000649359L","type":"CDM"}],"standard_charges":[{"gross_charge":8034.29,"discounted_cash":5624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYSTEM PACING TRANSCATH MICRA MICRATCPSYSTEM MC1VR01","code_information":[{"code":"Px0000658623L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":21031.0,"discounted_cash":14721.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRO MICRA HYDRPHL 23F MI2355A","code_information":[{"code":"Px0000658624L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.0,"discounted_cash":1292.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC 18MM AMPLATZER SEPTAL OCCLUDER 9PFO018","code_information":[{"code":"Px0000658688L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":26124.0,"discounted_cash":18286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT FLOSEAL HMOSTC NDLSS 5 ML","code_information":[{"code":"Px0000658729L","type":"CDM"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":330.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN PERF NV 25FR 50CM CB96345025","code_information":[{"code":"Px0000659510L","type":"CDM"}],"standard_charges":[{"gross_charge":1330.0,"discounted_cash":931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN PERF NV 8FR 19CM","code_information":[{"code":"Px0000659511L","type":"CDM"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":800.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN PERF NV 10FR 19CM","code_information":[{"code":"Px0000659512L","type":"CDM"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":800.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN PERF NV 12FR 19CM","code_information":[{"code":"Px0000659513L","type":"CDM"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":800.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN PERF NV 14FR 19CM","code_information":[{"code":"Px0000659514L","type":"CDM"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":800.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN PERF NV 27FR 50CM CB96345027","code_information":[{"code":"Px0000659515L","type":"CDM"}],"standard_charges":[{"gross_charge":1330.0,"discounted_cash":931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE CATH EXCHG WW TRAPPER","code_information":[{"code":"Px0000659937L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1082.0,"discounted_cash":757.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABL FLEX SNSR BI-D D-F AFASEDF","code_information":[{"code":"Px0000659954L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":5960.77,"discounted_cash":4172.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABL FLEX SNSR BI-D F-J AFASEFJ","code_information":[{"code":"Px0000659956L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":5960.77,"discounted_cash":4172.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRSG VAC VFLO CLEANSE CHCE MED ULTVCC05MDS","code_information":[{"code":"Px0000659988L","type":"CDM"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":473.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MODEL HIS RT SITE 43CM C315HIS01","code_information":[{"code":"Px0000660213L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.0,"discounted_cash":933.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MODEL HIS-02 RTSITE 43CM C315HIS02","code_information":[{"code":"Px0000660214L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE CHIKAI BLK SFT TIP 200CM AINCKI200BSFT","code_information":[{"code":"Px0000660391L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME FRAME 5 X 20 FC5203D","code_information":[{"code":"Px0000660426L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME FRAME 12 X 40 FC12403D","code_information":[{"code":"Px0000660444L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME FRAME 22 X 50 FC22503D","code_information":[{"code":"Px0000660454L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME FRAME 25 X 50 FC25503D","code_information":[{"code":"Px0000660455L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PRONTO LP 5FR","code_information":[{"code":"Px0000660686L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":895.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH DL 12.5F L27XL12CM","code_information":[{"code":"Px0000660694L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LIFESTREAM 6 X 16 X 80 LSMU0800616","code_information":[{"code":"Px0000661029L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LIFESTREAM 6X26X80 LSMU0800626","code_information":[{"code":"Px0000661030L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE ST .035 260CM LSMU0800637","code_information":[{"code":"Px0000661031L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LIFESTREAM 7X37X80 LSMU0800737","code_information":[{"code":"Px0000661035L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LIFESTREAM 8 X 37 X 80 LSMU0800837","code_information":[{"code":"Px0000661039L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LIFESTREAM 10 X 38 X 80 LSMU0801038","code_information":[{"code":"Px0000661043L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LIFESTREAM 10X58X80 LSMU0801058","code_information":[{"code":"Px0000661044L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT LIFESTREAM 8X58X136 LSMU1350858","code_information":[{"code":"Px0000661059L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6032.0,"discounted_cash":4222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LOOP RECORDER CONFIRM RX DM3500","code_information":[{"code":"Px0000664060L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":9611.0,"discounted_cash":6727.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MAP ACHIEVE ADV 20 MM 2ACH20","code_information":[{"code":"Px0000664063L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SICD 3501-45CM LEAD 3501","code_information":[{"code":"Px0000664094L","type":"CDM"},{"code":"C1896","type":"HCPCS"}],"standard_charges":[{"gross_charge":8320.0,"discounted_cash":5824.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVUS VISIONS PV .014P RX 014R","code_information":[{"code":"Px0000664657L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":2535.0,"discounted_cash":1774.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL INTERLOCK 35 2D 18X20","code_information":[{"code":"Px0000665572L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1991.0,"discounted_cash":1393.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PLNDRM PRECIS 14.5/44 8888146044P","code_information":[{"code":"Px0000665573L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1385.0,"discounted_cash":969.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WOLVERINE CUTTING BALLOON 3.00X10MM H74939401103000","code_information":[{"code":"Px0000665869L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2570.0,"discounted_cash":1799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WOLVERINE CUTTING BALLOON 3.50X10MM H74939401103500","code_information":[{"code":"Px0000665871L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2570.0,"discounted_cash":1799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CRNRY MR WLVRN 10X4.00MM H74939401104000","code_information":[{"code":"Px0000665873L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2570.0,"discounted_cash":1799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET GASTMY ENTUIT INIT SM","code_information":[{"code":"Px0000666227L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1319.0,"discounted_cash":923.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL POD J SFT 5CM RBYPODJ5 RBYPODJ5","code_information":[{"code":"Px0000666236L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 1 X 1","code_information":[{"code":"Px0000667967L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2882.0,"discounted_cash":2017.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 1 X 2","code_information":[{"code":"Px0000667968L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":1925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 1 X 3 OPTI0103HSS10","code_information":[{"code":"Px0000667969L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 1.5 X 2","code_information":[{"code":"Px0000667972L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 1.5 X 3","code_information":[{"code":"Px0000667973L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":1925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 2 X 1","code_information":[{"code":"Px0000667975L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 2 X 2 OPTI0202HSS10","code_information":[{"code":"Px0000667976L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CMPLX 2X3","code_information":[{"code":"Px0000667977L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CMPLX 2X4","code_information":[{"code":"Px0000667978L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPS FT HLX 2X6","code_information":[{"code":"Px0000667979L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPS FT HLX 2X8","code_information":[{"code":"Px0000667980L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 2.5 X 6","code_information":[{"code":"Px0000667983L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 3 X 10","code_information":[{"code":"Px0000667987L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPS FT HLX 4X6 OPTI0406HSS10","code_information":[{"code":"Px0000667988L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPS FT HLX 4X8 OPTI0408HSS10","code_information":[{"code":"Px0000667989L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 4 X 10","code_information":[{"code":"Px0000667990L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT HLX 5 X 10","code_information":[{"code":"Px0000667993L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 1 X 1 OPTI0101CSS10","code_information":[{"code":"Px0000668015L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.0,"discounted_cash":2449.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 1 X 2 OPTI0102CSS10","code_information":[{"code":"Px0000668016L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3449.0,"discounted_cash":2414.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH NEURON SELECT 5F 130 BER PNS5F130BER","code_information":[{"code":"Px0000668017L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3449.0,"discounted_cash":2414.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 1.5X2 OPTI0152CSS10","code_information":[{"code":"Px0000668019L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 1.5X3 OPTI0153CSS10","code_information":[{"code":"Px0000668020L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 1.5X4 OPTI0154CSS10","code_information":[{"code":"Px0000668021L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 2 X 2 OPTI0202CSS10","code_information":[{"code":"Px0000668022L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 2 X 3 OPTI0203CSS10","code_information":[{"code":"Px0000668023L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 2 X 4 OPTI0204CSS10","code_information":[{"code":"Px0000668024L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPS FT CMPLX 2X6 OPTI0206CSS10","code_information":[{"code":"Px0000668025L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 2 X 8 OPTI0208CSS10","code_information":[{"code":"Px0000668026L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 2.5 X 3 OPTI0253CSS10","code_information":[{"code":"Px0000668027L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 2.5 X 4 OPTI0254CSS10","code_information":[{"code":"Px0000668028L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 2.5 X 6 OPTI0256CSS10","code_information":[{"code":"Px0000668029L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 3 X 4 OPTI0304CSS10","code_information":[{"code":"Px0000668030L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 3 X 6 OPTI0306CSS10","code_information":[{"code":"Px0000668031L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 3 X 8 OPTI0308CSS10","code_information":[{"code":"Px0000668032L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 3 X 10 OPTI0310CSS10","code_information":[{"code":"Px0000668033L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 3.5 X 6 OPTI0356CSS10","code_information":[{"code":"Px0000668034L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 3.5 X 8 OPTI0358CSS10","code_information":[{"code":"Px0000668035L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 4 X 6 OPTI0406CSS10","code_information":[{"code":"Px0000668036L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPS FT CPLX 4X8","code_information":[{"code":"Px0000668037L","type":"CDM"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 4X10 OPTI0410CSS10","code_information":[{"code":"Px0000668038L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPS FT CPLX 5X8 OPTI0508CSS10","code_information":[{"code":"Px0000668039L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 5 X 10 OPTI0510CSS10","code_information":[{"code":"Px0000668040L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SPSFT CPLX 5 X 13 OPTI0513CSS10","code_information":[{"code":"Px0000668041L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 2 X 4 OPTI0204CSF10","code_information":[{"code":"Px0000668043L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 2X6 OPTI0206CSF10","code_information":[{"code":"Px0000668044L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 2X8 OPTI0208CSF10","code_information":[{"code":"Px0000668045L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 3 X 6 OPTI0306CSF10","code_information":[{"code":"Px0000668047L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 3 X 8 OPTI0308CSF10","code_information":[{"code":"Px0000668048L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT COMPLX 3X10 OPTI0310CSF10","code_information":[{"code":"Px0000668049L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 4 X 7 OPTI0407CSF10","code_information":[{"code":"Px0000668050L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT COMPLX 4X13 OPTI0413CSF10","code_information":[{"code":"Px0000668051L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 5X7 OPTI0517CSF10","code_information":[{"code":"Px0000668053L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 6X11 OPTI0611CSF10","code_information":[{"code":"Px0000668054L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 6 X 20 OPTI0620CSF10","code_information":[{"code":"Px0000668055L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 7 X 13 OPTI0713CSF10","code_information":[{"code":"Px0000668056L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 7 X 24 OPTI0724CSF10","code_information":[{"code":"Px0000668057L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA SFT CMPLX 8 X 27 OPTI0827CSF10","code_information":[{"code":"Px0000668059L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":2359.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA STD CMPLX 9 X 30 OPTI0930CST10","code_information":[{"code":"Px0000668068L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 7 X 24","code_information":[{"code":"Px0000668072L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 8 X 27","code_information":[{"code":"Px0000668073L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 9 X 30","code_information":[{"code":"Px0000668074L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 10 X 34 OPTI1034COM18","code_information":[{"code":"Px0000668075L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 11 X 37 OPTI1137COM18","code_information":[{"code":"Px0000668076L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 12 X 40","code_information":[{"code":"Px0000668077L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 13 X 43 OPTI1343COM18","code_information":[{"code":"Px0000668078L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 14 X 47","code_information":[{"code":"Px0000668079L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 15 X 50 OPTI1550COM18","code_information":[{"code":"Px0000668080L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 16 X 55","code_information":[{"code":"Px0000668081L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 18 X 60","code_information":[{"code":"Px0000668082L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 20 X 65","code_information":[{"code":"Px0000668083L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 22 X 65","code_information":[{"code":"Px0000668084L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMA 18 CMPLX 24 X 65","code_information":[{"code":"Px0000668085L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYS COIL DETACH XCEL OPTIMA XCEL XCEL","code_information":[{"code":"Px0000668086L","type":"CDM"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT RESLT ONYX 2.0 X 8MM RONYX20008UX","code_information":[{"code":"Px0000668132L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT RESLT ONYX 2.0 X 12MM RONYX20012UX","code_information":[{"code":"Px0000668133L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT RESLT ONYX 2.0 X 22MM RONYX20022UX","code_information":[{"code":"Px0000668136L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH 3F 5CM N/WIRE .018 TPR","code_information":[{"code":"Px0000668156L","type":"CDM"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE SPR .030 2 CM FLPY 140 CM J","code_information":[{"code":"Px0000668157L","type":"CDM"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD VIGILANT ER DR DF4 PVD9","code_information":[{"code":"Px0000668166L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18488.0,"discounted_cash":12941.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD MOMENTUM EL D PMD9","code_information":[{"code":"Px0000668167L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18906.0,"discounted_cash":13234.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD VIGILANT EL VR DF4 PVS9","code_information":[{"code":"Px0000668168L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15325.0,"discounted_cash":10727.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD MOMENTUM EL VR PMS9","code_information":[{"code":"Px0000668169L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15325.0,"discounted_cash":10727.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D VIGILANT X4 IS4 DF4 PV49","code_information":[{"code":"Px0000668170L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24265.0,"discounted_cash":16985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D MOMENTUM X4 IS 4 DF1 PM49","code_information":[{"code":"Px0000668171L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24265.0,"discounted_cash":16985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D MOMENTUM IS1 DF4 PM19","code_information":[{"code":"Px0000668172L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":22965.0,"discounted_cash":16075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D MOMENTUM IS 1 DF1 PM18","code_information":[{"code":"Px0000668173L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":22965.0,"discounted_cash":16075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D MOMENTUM LV-1 PM17","code_information":[{"code":"Px0000668174L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":22965.0,"discounted_cash":16075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMP KIT LVAD HEARTMATE3","code_information":[{"code":"Px0000668217L","type":"CDM"}],"standard_charges":[{"gross_charge":210486.0,"discounted_cash":147340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEUROFORM ATLAS 3.0X15","code_information":[{"code":"Px0000668598L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":18022.0,"discounted_cash":12615.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEUROFORM ATLAS 3.0X24","code_information":[{"code":"Px0000668600L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":18022.0,"discounted_cash":12615.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEUROFORM ATLAS 4.0X21MM M003SZAS40210","code_information":[{"code":"Px0000668601L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":18022.0,"discounted_cash":12615.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEUROFORM ATLAS 4.0X24","code_information":[{"code":"Px0000668602L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":18022.0,"discounted_cash":12615.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEUROFORM ATLAS 4.5X21 M003SZAS45210","code_information":[{"code":"Px0000668603L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":18022.0,"discounted_cash":12615.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEUROFORM ATLAS 4.5X30 M003SZAS45300","code_information":[{"code":"Px0000668604L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":18022.0,"discounted_cash":12615.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CTRLR PCKT LVAD HEARTMATE 3","code_information":[{"code":"Px0000668661L","type":"CDM"},{"code":"Q0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":16364.0,"discounted_cash":11454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CABLE MOD LVAD HEARTMATE 3","code_information":[{"code":"Px0000668742L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":12830.0,"discounted_cash":8981.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 8X12 45750812","code_information":[{"code":"Px0000668838L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROBE MWA CERTUS PREC PR15","code_information":[{"code":"Px0000669365L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":5292.0,"discounted_cash":3704.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MAP SNSR ENABLED BI-D DAVHDDF16","code_information":[{"code":"Px0000670768L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":7084.91,"discounted_cash":4959.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PED ANGIO MP TID 3.3X80","code_information":[{"code":"Px0000670976L","type":"CDM"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN SAPPHIRE 2 PRO 1.25MMX10MM 2121035UU","code_information":[{"code":"Px0000672579L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 2.25MMX12MM 155022512","code_information":[{"code":"Px0000675050L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 2.50MMX15MM 155025015","code_information":[{"code":"Px0000675059L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 3.00MMX8MM 155030008","code_information":[{"code":"Px0000675073L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 3.00MMX12MM 155030012","code_information":[{"code":"Px0000675074L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 3.00MMX15MM 155030015","code_information":[{"code":"Px0000675075L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 3.00MMX23MM 155030023","code_information":[{"code":"Px0000675077L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 3.50MMX23MM 155035023","code_information":[{"code":"Px0000675093L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 3.50MMX28MM 155035028","code_information":[{"code":"Px0000675094L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 4.00MMX23MM 155040023","code_information":[{"code":"Px0000675101L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1890.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THROMB LG 140CM CATRXKIT","code_information":[{"code":"Px0000675251L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5722.0,"discounted_cash":4005.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE 6.5X60MM M732LPBC6560DX1","code_information":[{"code":"Px0000675596L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":8278.0,"discounted_cash":5794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X60X135","code_information":[{"code":"Px0000676896L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X80X135 H74939206040810","code_information":[{"code":"Px0000676897L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X100X135 H74939206041010","code_information":[{"code":"Px0000676898L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X120X135 H74939206041510","code_information":[{"code":"Px0000676900L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X200X135 H74939206042010","code_information":[{"code":"Px0000676901L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 5X80X135 H74939206050810","code_information":[{"code":"Px0000676903L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 6X80X135 H74939206060810","code_information":[{"code":"Px0000676906L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 7X80X135 H74939206070810","code_information":[{"code":"Px0000676909L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 7X150X135 H74939206071510","code_information":[{"code":"Px0000676911L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 9X40X135 H74939206090410","code_information":[{"code":"Px0000676918L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 10X20X75","code_information":[{"code":"Px0000677097L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 10X60X75 H74939206100670","code_information":[{"code":"Px0000677099L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X20X75 H74939206040270","code_information":[{"code":"Px0000677115L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X60X75","code_information":[{"code":"Px0000677117L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 4X80X75 H74939206040870","code_information":[{"code":"Px0000677118L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 5X80X75 H74939206050870","code_information":[{"code":"Px0000677123L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 6X80X75 H74939206060870","code_information":[{"code":"Px0000677128L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 7X80X75 H74939206070870","code_information":[{"code":"Px0000677133L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 8X60X75 H74939206080670","code_information":[{"code":"Px0000677137L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 8X80X75 H74939206080870","code_information":[{"code":"Px0000677138L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN CHARGER 9X80X75 H74939206090870","code_information":[{"code":"Px0000677142L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 8X60X135 H74939171080610","code_information":[{"code":"Px0000677341L","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC WSTNT UNISTEP 6FR 8X80X75 M001711300","code_information":[{"code":"Px0000677705L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":2600.0,"discounted_cash":1820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLL CANSTR W/ TUBING RIPTIDE MAC1200","code_information":[{"code":"Px0000678627L","type":"CDM"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":740.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ASPIR REACT 68 REACT68","code_information":[{"code":"Px0000678628L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5621.0,"discounted_cash":3934.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN LTNX AV .035 10X60X75 LX35751060V","code_information":[{"code":"Px0000678639L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN LTNX AV .035 12X40X75 LX35751240V","code_information":[{"code":"Px0000678641L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN LTNX AV .035 8X60X75 LX3575860V","code_information":[{"code":"Px0000678671L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH HIS-RV 5F 4-23-4MM 120CM","code_information":[{"code":"Px0000679141L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1454.0,"discounted_cash":1017.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO SYS HEMOSTAT EP 3FRX7CM","code_information":[{"code":"Px0000679306L","type":"CDM"},{"code":"C2629","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDGO 6 W/LG LUMEN TBNG CAT6KIT","code_information":[{"code":"Px0000679379L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":6764.0,"discounted_cash":4734.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDGO 8 W/ TBNG TORQ TIP CAT8TORQ85KIT","code_information":[{"code":"Px0000679381L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9670.0,"discounted_cash":6769.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDGO 8 W/TBNG XTORQ TIP EA CAT8XTORQ115KIT","code_information":[{"code":"Px0000679382L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":10379.0,"discounted_cash":7265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4307.0,"discounted_cash":3014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PRIM .020 VES 8-10MM RBYPOD10","code_information":[{"code":"Px0000679386L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5377.0,"discounted_cash":3763.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PRIM .020VES 10-12MM RBYPOD12","code_information":[{"code":"Px0000679387L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5860.0,"discounted_cash":4102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PRIM .020 VES 3MM EA 1 EA RBYPOD3","code_information":[{"code":"Px0000679389L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5860.0,"discounted_cash":4102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY PICC MAX BARER TL 5FR","code_information":[{"code":"Px0000679426L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.69,"discounted_cash":925.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE S4 4.0X4.0 S4IVL4040","code_information":[{"code":"Px0000679528L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":8278.0,"discounted_cash":5794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CLOTTRIEVER 16MM 40102","code_information":[{"code":"Px0000679552L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13200.0,"discounted_cash":9240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CLOTTRIEVER 50101","code_information":[{"code":"Px0000679553L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":6080.0,"discounted_cash":4256.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TOURGDE 90CM 9MM 6.5FR TG0659009","code_information":[{"code":"Px0000680298L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2201.2,"discounted_cash":1540.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TOURGDE 90CM 17MM 8.5FR TG0859017","code_information":[{"code":"Px0000680300L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2201.2,"discounted_cash":1540.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE ARISTTL SFT 200CM","code_information":[{"code":"Px0000680312L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.33,"discounted_cash":1284.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IV ANTIMIC PRBE 10CMX18GA F118108PT","code_information":[{"code":"Px0000680426L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS JET 7 W/TBNG 5MAXJET7KIT","code_information":[{"code":"Px0000680704L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8567.0,"discounted_cash":5996.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ICE VIEWFLEX XTRA 9FR-REP","code_information":[{"code":"Px0000680728L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3057.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DIL ATLAS GLD 16X02X120 ATG120162","code_information":[{"code":"Px0000681193L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.0,"discounted_cash":1047.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH AZUR 32CX16M 45751632","code_information":[{"code":"Px0000681237L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ANGIO BT 5F 90CMX .038IN G57017","code_information":[{"code":"Px0000681248L","type":"CDM"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD RELIANCE DF4 0272 0272","code_information":[{"code":"Px0000681404L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":4509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD RELIANCE DF4 0273 0273","code_information":[{"code":"Px0000681405L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":4509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANISTER ENGINE PENUMBRA PAPS3","code_information":[{"code":"Px0000684318L","type":"CDM"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":866.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT ADM 4X200MM 130CM ADM04020013P","code_information":[{"code":"Px0000688176L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5787.0,"discounted_cash":4050.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT ADM 5X200MM 130CM ADM05020013P","code_information":[{"code":"Px0000688178L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4618.0,"discounted_cash":3232.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT ADM 6X200MM 130CM ADM06020013P","code_information":[{"code":"Px0000688180L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4618.0,"discounted_cash":3232.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT ADM 4X250MM 130 CM ADM04025013P","code_information":[{"code":"Px0000688182L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":6548.0,"discounted_cash":4583.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN PACT ADM 5X250MM 130CM ADM05025013P","code_information":[{"code":"Px0000688184L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5814.0,"discounted_cash":4069.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT ADM 6X250MM 130 CM ADM06025013P","code_information":[{"code":"Px0000688186L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5814.0,"discounted_cash":4069.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO AGILIS NXT MED CURL 71CM G408321","code_information":[{"code":"Px0000688189L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3092.42,"discounted_cash":2164.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH GDE DEST SLNDR ST 6X119 GSR6ST1C12W","code_information":[{"code":"Px0000701005L","type":"CDM"}],"standard_charges":[{"gross_charge":1449.92,"discounted_cash":1014.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT MINI APICAL CUFF W/HOLDER","code_information":[{"code":"Px0000702256L","type":"CDM"}],"standard_charges":[{"gross_charge":2112.0,"discounted_cash":1478.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE HYB STR .012/.014IN HYBRID1214D","code_information":[{"code":"Px0000702865L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE HYB DBL ANG .012/.014IN HYBRID1214DA","code_information":[{"code":"Px0000702866L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2037.0,"discounted_cash":1425.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ATLAS GLD 14MMX20MMX120CM ATG120142","code_information":[{"code":"Px0000702906L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":978.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT PUMP BLD TANSEMHRT 29FR","code_information":[{"code":"Px0000702931L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":50702.0,"discounted_cash":35491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP CRD 5-5-5 4FR 120 CM-REP","code_information":[{"code":"Px0000703506L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.35,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH EP LG CRV 2-5-2 5FX110REP","code_information":[{"code":"Px0000704150L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEALANT TISSEEL PRIMA FZ 4ML 1506079","code_information":[{"code":"Px0000704803L","type":"CDM"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEALANT TISSEEL PRIMA FZ 10ML 1506080","code_information":[{"code":"Px0000704804L","type":"CDM"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":870.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABL TACTI BI-D D-F CRV ATCSEDF","code_information":[{"code":"Px0000710182L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":9441.0,"discounted_cash":6608.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABL TACTI BI-D F-J CRV ATCSEFJ","code_information":[{"code":"Px0000710184L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":9441.0,"discounted_cash":6608.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH W/CRV VIZIGO LG 8.5FR","code_information":[{"code":"Px0000710224L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2861.0,"discounted_cash":2002.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH W/CRV VIZIGO MED 8.5 FR D138502","code_information":[{"code":"Px0000710225L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2861.0,"discounted_cash":2002.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCER DVILL 12F 85CM .035 612844","code_information":[{"code":"Px0000710295L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.86,"discounted_cash":847.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT GWIRE SAFESEPT NDL-FREE","code_information":[{"code":"Px0000710301L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO AGILIS NXT 16.8X71CM","code_information":[{"code":"Px0000710322L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2015.0,"discounted_cash":1410.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO AGILIS NXT 22.4X71CM REP","code_information":[{"code":"Px0000710323L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":1372.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH JUG DL 26FR 3/8 30CM 70126","code_information":[{"code":"Px0000710339L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7675.0,"discounted_cash":5372.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH JUG DL 32FR 3/8 30CM 70132","code_information":[{"code":"Px0000710341L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7675.0,"discounted_cash":5372.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 14 CM 10MM G47345","code_information":[{"code":"Px0000710764L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 20CM 12MM G47357","code_information":[{"code":"Px0000710784L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 20CM 16MM G47359","code_information":[{"code":"Px0000710786L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MICRONESTER .018 14CM 3MM","code_information":[{"code":"Px0000710788L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MICRONESTER .018 14 CM 4MM","code_information":[{"code":"Px0000710789L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MICRONESTER .018 14CM 6MM G47329","code_information":[{"code":"Px0000710790L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL MICRONESTER .018 14CM 8MM G47330","code_information":[{"code":"Px0000710791L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 14CM 12MM G47346","code_information":[{"code":"Px0000710792L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 14 CM 4MM G47352","code_information":[{"code":"Px0000710793L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 14CM 6MM G47354","code_information":[{"code":"Px0000710794L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL NESTER .035 20CM 18MM G47360","code_information":[{"code":"Px0000710809L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ATLAS GLD 12MMX40MMX120CM","code_information":[{"code":"Px0000710841L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":978.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD RELI 4 FRNT 59CM SNGL 0672","code_information":[{"code":"Px0000711185L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":4509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD RELI 4 FRNT 6CM SNGL 0673","code_information":[{"code":"Px0000711186L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.0,"discounted_cash":4509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH LNG BALLAST 088 80CM BALLAST80","code_information":[{"code":"Px0000711231L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.0,"discounted_cash":1107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH LNG BALLAST 088 90CM BALLAST90","code_information":[{"code":"Px0000711232L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.0,"discounted_cash":1107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-P MRI QUADRA ALLURE MP PM3562","code_information":[{"code":"Px0000711245L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":11770.0,"discounted_cash":8239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE REVASC SOLITAIRE X 6X40 SFR464010","code_information":[{"code":"Px0000711362L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13794.0,"discounted_cash":9655.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE REVAS SOLITAIRE X6X24","code_information":[{"code":"Px0000711363L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13794.0,"discounted_cash":9655.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE REVAS SOLITAIRE 4X40 SFR444010","code_information":[{"code":"Px0000711365L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13794.0,"discounted_cash":9655.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE REVASC SLTR X4X20-05 SFR442005","code_information":[{"code":"Px0000711367L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13794.0,"discounted_cash":9655.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PHENOM 21 160 CM FG1316006151S","code_information":[{"code":"Px0000711368L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3647.0,"discounted_cash":2552.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PHENOM 27 160CM FG1516006151S","code_information":[{"code":"Px0000711369L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3647.0,"discounted_cash":2552.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4600.0,"discounted_cash":3220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5526.0,"discounted_cash":3868.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-P PERCEPTA MRI W1TR01","code_information":[{"code":"Px0000711380L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":11206.0,"discounted_cash":7844.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-P PERCEPTA MRI QUAD W4TR01","code_information":[{"code":"Px0000711381L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":11770.0,"discounted_cash":8239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D CLARIA MRI DF4 DTMA1D4","code_information":[{"code":"Px0000711382L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":22965.0,"discounted_cash":16075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D CLARIA MRI DF1 DTMA1D1","code_information":[{"code":"Px0000711383L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":22965.0,"discounted_cash":16075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D CLARIA MRI QUAD DF4 DTMA1QQ","code_information":[{"code":"Px0000711384L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24266.0,"discounted_cash":16986.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D CLARIA MRI QUAD DF1 DTMA1Q1","code_information":[{"code":"Px0000711385L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24266.0,"discounted_cash":16986.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ABL ARTIC DRNT ADV PRO28 AFAPRO28","code_information":[{"code":"Px0000716950L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEV INTRASCCLR WEB SL 9X5","code_information":[{"code":"Px0000717217L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":37824.0,"discounted_cash":26476.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROCATH .027IN 3.2FR 154CM VIA2715401","code_information":[{"code":"Px0000717237L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3906.0,"discounted_cash":2734.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CTRLR DETCHMNT WEB WDC1","code_information":[{"code":"Px0000717239L","type":"CDM"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEE EXT SET 14F 2.3X30CM","code_information":[{"code":"Px0000717833L","type":"CDM"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":958.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VNVO 8F 12X60MM 80CM VENUM12060","code_information":[{"code":"Px0000718027L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5290.0,"discounted_cash":3703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VNVO 8F 12X80MM 80CM VENUM12080","code_information":[{"code":"Px0000718028L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5290.0,"discounted_cash":3703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANSTR ENGINE FOR INDIGO SYSTE IAPS3","code_information":[{"code":"Px0000720439L","type":"CDM"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH PINN PRECS ACC 4FR STIF 704165","code_information":[{"code":"Px0000720646L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.61,"discounted_cash":268.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VPRWR FLX GEN 2 .014 TIP 335CM VPRGWFLEX14","code_information":[{"code":"Px0000720697L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.2,"discounted_cash":517.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC APPLIC HMOST FLOSEAL FAST 5ML ADS201844","code_information":[{"code":"Px0000723899L","type":"CDM"}],"standard_charges":[{"gross_charge":747.07,"discounted_cash":522.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PORT INFUS APHER 9.6 FR A710962","code_information":[{"code":"Px0000723916L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2063.0,"discounted_cash":1444.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DFLCT SLC TS ITE 9I 43 CM","code_information":[{"code":"Px0000724362L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":1023.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FCP MINI PULM COREDX M00515220","code_information":[{"code":"Px0000724574L","type":"CDM"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":1192.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD SURESCAN 479888","code_information":[{"code":"Px0000724734L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE SFT PRFL .018 10CMX200CM A18-200-001","code_information":[{"code":"Px0000725393L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2180.43,"discounted_cash":1526.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH VASC ACC ELLIPSYS 6F AMI6005","code_information":[{"code":"Px0000725964L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":22644.0,"discounted_cash":15850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT SYS NEURFRM ATLAS 3.0X15 M003UZAS30150","code_information":[{"code":"Px0000726139L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":19508.94,"discounted_cash":13656.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT SYS NEURFRM ATLAS 3.0X21 M003UZAS30210","code_information":[{"code":"Px0000726140L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":19508.94,"discounted_cash":13656.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT SYS NEURFRM ATLAS 3.0X24 M003UZAS30240","code_information":[{"code":"Px0000726141L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":16843.0,"discounted_cash":11790.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT SYS NEURFRM ATLAS 4.0X21 M003UZAS40210","code_information":[{"code":"Px0000726142L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":19508.94,"discounted_cash":13656.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT SYS NEURFRM ATLAS 4.0X24 M003UZAS40240","code_information":[{"code":"Px0000726143L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":19508.94,"discounted_cash":13656.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT SYS NEURFRM ATLAS 4.5X21 M003UZAS45210","code_information":[{"code":"Px0000726144L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":19917.01,"discounted_cash":13941.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT SYS NEURFRM ATLAS 4.5X30 M003UZAS45300","code_information":[{"code":"Px0000726145L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":19917.01,"discounted_cash":13941.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DELY ASST AXS OFF 050X150 M003DC050150A0","code_information":[{"code":"Px0000726146L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3097.0,"discounted_cash":2167.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DELY SYS SURPASS 5X30MM M003SFD050300","code_information":[{"code":"Px0000726156L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":36227.0,"discounted_cash":25358.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT PROVENA SL W/BIOPATCH S4153108BDP","code_information":[{"code":"Px0000726229L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":899.0,"discounted_cash":629.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MIC RENEGADE STR 150/30","code_information":[{"code":"Px0000726234L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC CMPLX SFT 8MMX20CM 4004C0820","code_information":[{"code":"Px0000726281L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6900.0,"discounted_cash":4830.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASC CMPLX XSFT 2MMX4CM 4006C0204","code_information":[{"code":"Px0000726292L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5803.0,"discounted_cash":4062.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICCATH BLN OCCL STR-TIP 150CM SBC0629STR150","code_information":[{"code":"Px0000726304L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3262.0,"discounted_cash":2283.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH JETI STRL 8FR WV8803","code_information":[{"code":"Px0000726481L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12990.0,"discounted_cash":9093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH JETI STRL 6FR WV6203","code_information":[{"code":"Px0000726482L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":10198.0,"discounted_cash":7138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEV EMBL ASST COMNCI 32MM .021 ANPP7177","code_information":[{"code":"Px0000740298L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":11610.0,"discounted_cash":8127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEV EMBL ASST COMNCI 22MM .017 ANPP7199","code_information":[{"code":"Px0000740300L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":12423.0,"discounted_cash":8696.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ECLIPSE BLN DL 6X9 ECL2L6X9","code_information":[{"code":"Px0000755576L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5238.0,"discounted_cash":3666.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ECLPSE BLN DL 6X12 ECL2L6X12 ECL2L6X12","code_information":[{"code":"Px0000755577L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5605.0,"discounted_cash":3923.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ECLPSE BLN DL 6X15 ECL2L6X15","code_information":[{"code":"Px0000755578L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5238.0,"discounted_cash":3666.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ECLPSE BLN DL 6X20","code_information":[{"code":"Px0000755579L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5605.0,"discounted_cash":3923.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ECLPSE BLN DL ECL2L6X7SN","code_information":[{"code":"Px0000755580L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":6057.0,"discounted_cash":4239.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH JUG DL 30FR 3/8IN 30CM 70130","code_information":[{"code":"Px0000759106L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7675.0,"discounted_cash":5372.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 1MMX2CM RBYLP0102","code_information":[{"code":"Px0000759513L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2568.0,"discounted_cash":1797.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 1MMX5CM RBYLP0105","code_information":[{"code":"Px0000759514L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 2MMX2CM RBYLP0202","code_information":[{"code":"Px0000759515L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 2MMX4CM RBYLP0204","code_information":[{"code":"Px0000759516L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 2MMX10CM RBYLP0210","code_information":[{"code":"Px0000759517L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 3MMX4CM RBYLP0304","code_information":[{"code":"Px0000759518L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2568.0,"discounted_cash":1797.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 3MMX10CM RBYLP0310","code_information":[{"code":"Px0000759519L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 3MMX15CM RBYLP0315","code_information":[{"code":"Px0000759520L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 4MMX6CM RBYLP0406","code_information":[{"code":"Px0000759521L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 4MMX15CM RBYLP0415","code_information":[{"code":"Px0000759522L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 4MMX30CM RBYLP0430","code_information":[{"code":"Px0000759523L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL RUBY LP 5MMX10CM RBYLP0510","code_information":[{"code":"Px0000759524L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 5MMX30CM RBYLP0530","code_information":[{"code":"Px0000759525L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 6MMX10CM RBYLP0610","code_information":[{"code":"Px0000759526L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 6MMX30CM RBYLP0630","code_information":[{"code":"Px0000759527L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL RUBY LP 7MMX40CM RBYLP0740","code_information":[{"code":"Px0000759528L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 8MM X 60 CM RBYLP0860","code_information":[{"code":"Px0000759529L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 3CM RBYPCLP03","code_information":[{"code":"Px0000759530L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 6CM RBYPCLP06","code_information":[{"code":"Px0000759531L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 10CM RBYPCLP10","code_information":[{"code":"Px0000759532L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 15CM RBYPCLP15","code_information":[{"code":"Px0000759533L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 30CM RBYPCLP30","code_information":[{"code":"Px0000759534L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 45CM RBYPCLP45","code_information":[{"code":"Px0000759535L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 60CM RBYPCLP60","code_information":[{"code":"Px0000759536L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HANDLE DETCHMNT LP SYS RLPH1","code_information":[{"code":"Px0000759537L","type":"CDM"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":692.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 8X40X80 7F IAV08004008P","code_information":[{"code":"Px0000760106L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AVDCB 8X60X80 7F IAV08006008P","code_information":[{"code":"Px0000760109L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 8X80X80 7FR IAV08008008P","code_information":[{"code":"Px0000760112L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 9X40X80 7F IAV09004008P","code_information":[{"code":"Px0000760115L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5290.0,"discounted_cash":3703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 9X60X80 7F IAV09006008P","code_information":[{"code":"Px0000760118L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 9X80X80 7F IAV09008008P","code_information":[{"code":"Px0000760121L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 10X40X80 7F IAV10004008P","code_information":[{"code":"Px0000760124L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLN IN.PACT AV DCB 12X40X80 9F IAV12004008P","code_information":[{"code":"Px0000760127L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL POD400 5CM 400POD5","code_information":[{"code":"Px0000760514L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5222.0,"discounted_cash":3655.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBL POD400 6CM 400POD6","code_information":[{"code":"Px0000760515L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5222.0,"discounted_cash":3655.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PROVENA PICC SL 3FR","code_information":[{"code":"Px0000761449L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.17,"discounted_cash":839.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PROVENA PICC DL 4FR","code_information":[{"code":"Px0000761450L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.3,"discounted_cash":861.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CLOTTRIEVER 16FRX15CM 51101","code_information":[{"code":"Px0000761468L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":6366.0,"discounted_cash":4456.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 1X3CM OPTI0103CSSMX","code_information":[{"code":"Px0000761552L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5389.0,"discounted_cash":3772.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 1.5X2C OPTI0152CSSMX","code_information":[{"code":"Px0000761553L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 1.5X3C OPTI0153CSSMX","code_information":[{"code":"Px0000761554L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.0,"discounted_cash":4729.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 2X2CM OPTI0202CSSMX","code_information":[{"code":"Px0000761555L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 2X3CM OPTI0203CSSMX","code_information":[{"code":"Px0000761556L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5642.6,"discounted_cash":3949.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 2X4CM OPTI0204CSSMX","code_information":[{"code":"Px0000761557L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 2X6CM OPTI0206CSSMX","code_information":[{"code":"Px0000761558L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX 2.5X2.5CM OPTI2525CSSMX","code_information":[{"code":"Px0000761559L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5207.0,"discounted_cash":3644.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX 2.5X5CM OPTI0255CSSMX","code_information":[{"code":"Px0000761560L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 3X3CM OPTI0303CSSMX","code_information":[{"code":"Px0000761561L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 3X7CM OPTI0307CSSMX","code_information":[{"code":"Px0000761562L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SSFT 3X10CM OPTI0310CSSMX","code_information":[{"code":"Px0000761563L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5389.0,"discounted_cash":3772.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX 3.5X5CM OPTI0355CSSMX","code_information":[{"code":"Px0000761565L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX 3.5X8CM OPTI0358CSSMX","code_information":[{"code":"Px0000761566L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 4X4CM OPTI0404CSFMX","code_information":[{"code":"Px0000761567L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 4X7CM OPTI0407CSFMX","code_information":[{"code":"Px0000761568L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 4X10CM OPTI0410CSFMX","code_information":[{"code":"Px0000761569L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 4X13CM OPTI0413CSFMX","code_information":[{"code":"Px0000761570L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5389.0,"discounted_cash":3772.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 5X7CM OPTI0507CSFMX","code_information":[{"code":"Px0000761573L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 5X10CM OPTI0510CSFMX","code_information":[{"code":"Px0000761574L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 5X17CM OPTI0517CSFMX","code_information":[{"code":"Px0000761575L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5389.0,"discounted_cash":3772.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 6X11CM OPTI0611CSFMX","code_information":[{"code":"Px0000761576L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5207.0,"discounted_cash":3644.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 6X15CM OPTI0615CSFMX","code_information":[{"code":"Px0000761577L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5389.0,"discounted_cash":3772.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 6X20CM OPTI0620CSFMX","code_information":[{"code":"Px0000761578L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5389.0,"discounted_cash":3772.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 7X15CM OPTI0715CSFMX","code_information":[{"code":"Px0000761579L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 7X20CM OPTI0720CSFMX","code_information":[{"code":"Px0000761580L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 8X20CM OPTI0820CSFMX","code_information":[{"code":"Px0000761581L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 8X30CM OPTI0830CSFMX","code_information":[{"code":"Px0000761582L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 9X30CM OPTI0930CSFMX","code_information":[{"code":"Px0000761583L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL OPTIMAX CMPLX SFT 10X40CM OPTI1040CSFMX","code_information":[{"code":"Px0000761584L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5571.0,"discounted_cash":3899.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEPHURET 8FR 22CM","code_information":[{"code":"Px0000761727L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4990.0,"discounted_cash":3493.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEPHURET 8FR 24CM","code_information":[{"code":"Px0000761728L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4990.0,"discounted_cash":3493.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT NEPHURET 8FR 26CM","code_information":[{"code":"Px0000761729L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4990.0,"discounted_cash":3493.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH OTW LUTONIX 7X80X130 LX351307805F","code_information":[{"code":"Px0000761812L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH OTW LUTONIX 7X100X130 LX3513071005F","code_information":[{"code":"Px0000761813L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3383.01,"discounted_cash":2368.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH OTW LUTONIX 7X120X130 LX3513071205F","code_information":[{"code":"Px0000761814L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH OTW LUTONIX 7X150X130 LX3513071505F","code_information":[{"code":"Px0000761815L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3900.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYS PACE TRANSCATH MICRA AV MICRAAVTCPSYSTEM","code_information":[{"code":"Px0000762043L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":30455.0,"discounted_cash":21318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD PACING INGEVITY 45 CM 7840","code_information":[{"code":"Px0000762561L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD PACING INGEVITY 52 CM 7841","code_information":[{"code":"Px0000762562L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD PACING INGEVITY 59 CM 7842","code_information":[{"code":"Px0000762563L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PACING EXTEND HOOK SSPC3 9183","code_information":[{"code":"Px0000762566L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.0,"discounted_cash":1187.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO TRNS 6F 60CM 406800","code_information":[{"code":"Px0000763552L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH CRCLR ADVISOR DF DUO DPLR","code_information":[{"code":"Px0000763690L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":5403.0,"discounted_cash":3782.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SWAN-GANZ 8FR 110CM 777F8","code_information":[{"code":"Px0000764507L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.0,"discounted_cash":933.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MAP ACQMAP 25 MM 100CM 900003US","code_information":[{"code":"Px0000766116L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":12241.0,"discounted_cash":8568.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH STEER ACQGUIDE 12.8 FR 900002US","code_information":[{"code":"Px0000766117L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2782.0,"discounted_cash":1947.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRO ACQREF 7 FR 900005","code_information":[{"code":"Px0000766118L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT ELCTRD AQCMAP PAT 800365003","code_information":[{"code":"Px0000766119L","type":"CDM"}],"standard_charges":[{"gross_charge":2782.0,"discounted_cash":1947.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH ACCESS IMPELLA 5.5 0550-0008","code_information":[{"code":"Px0000766187L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":74900.0,"discounted_cash":52430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYSTEM GDE BLN CATH .087X95CM EA BG8087095","code_information":[{"code":"Px0000766446L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5099.0,"discounted_cash":3569.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 12X60X75CM H74912044126070","code_information":[{"code":"Px0000772348L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3113.0,"discounted_cash":2179.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 12X90X75CM H74912044129070","code_information":[{"code":"Px0000772349L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 14X40X75CM H74912044144070","code_information":[{"code":"Px0000772351L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 14X60X75CM H74912044146070","code_information":[{"code":"Px0000772352L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3113.0,"discounted_cash":2179.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 14X90X75CM H74912044149070","code_information":[{"code":"Px0000772353L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 16X40X75CM H74912044164070","code_information":[{"code":"Px0000772355L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 16X60X75CM H74912044166070","code_information":[{"code":"Px0000772356L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3113.0,"discounted_cash":2179.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 16X90X75CM H74912044169070","code_information":[{"code":"Px0000772357L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 18X40X75CM H74912044184070","code_information":[{"code":"Px0000772358L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3072.0,"discounted_cash":2150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 18X60X75CM H74912044186070","code_information":[{"code":"Px0000772359L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 18X90X75CM H74912044189070","code_information":[{"code":"Px0000772360L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 20X80X75CM H74912044208070","code_information":[{"code":"Px0000772363L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 10X68X75CM","code_information":[{"code":"Px0000772369L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT VEN WALLSTENT 10X94X75CM H74912044109470","code_information":[{"code":"Px0000772370L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CANN VEN 21FR 69.9CM 96600121","code_information":[{"code":"Px0000774270L","type":"CDM"}],"standard_charges":[{"gross_charge":1425.0,"discounted_cash":997.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 16FR 65CM DSF1665","code_information":[{"code":"Px0000774869L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"discounted_cash":1850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET EXT MIC-KY ENFIT 14FR 2.0C 8140142","code_information":[{"code":"Px0000774909L","type":"CDM"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT FEED JEJU 14FR 2.0CM","code_information":[{"code":"Px0000774977L","type":"CDM"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT FEED JEJU 18FR 2.5CM","code_information":[{"code":"Px0000774983L","type":"CDM"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET EXT JEJU 16FR 1.7CM","code_information":[{"code":"Px0000775009L","type":"CDM"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET EXT JEJU 16FR 2.3CM 8270162330","code_information":[{"code":"Px0000775013L","type":"CDM"},{"code":"775013L","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.0,"discounted_cash":1045.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET EXT JEJU 18FR 3.5CM","code_information":[{"code":"Px0000775039L","type":"CDM"}],"standard_charges":[{"gross_charge":1493.0,"discounted_cash":1045.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE OMNI STR TIP 185CM 89185","code_information":[{"code":"Px0000775040L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1476.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACC SYS BMX96 90 STR 125 SIM BMX9690SIM125","code_information":[{"code":"Px0000776925L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3046.0,"discounted_cash":2132.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BNCHMRK BMX96 80CM BMX9680","code_information":[{"code":"Px0000776928L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3046.0,"discounted_cash":2132.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BNCHMRK BMX96 90CM BMX9690","code_information":[{"code":"Px0000776929L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3046.0,"discounted_cash":2132.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DES SYNGY XD MR 5.00X20M H7493941820500","code_information":[{"code":"Px0000776996L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1732.0,"discounted_cash":1212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DES SYNGY XD MR 5.00X32M H7493941832500","code_information":[{"code":"Px0000776999L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"discounted_cash":998.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT PROTEKDUO LS SL31 58203118","code_information":[{"code":"Px0000777002L","type":"CDM"}],"standard_charges":[{"gross_charge":47385.0,"discounted_cash":33169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD GALLANT VR CDVRA500Q","code_information":[{"code":"Px0000780538L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15324.0,"discounted_cash":10726.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD GALLANT DR CDDRA500Q","code_information":[{"code":"Px0000780539L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18489.0,"discounted_cash":12942.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D GALLANT HF CDHFA500Q","code_information":[{"code":"Px0000780540L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24266.0,"discounted_cash":16986.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS JET 7 STD TIP 5MAXJET7BKIT","code_information":[{"code":"Px0000780640L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8567.0,"discounted_cash":5996.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MONITOR CARDIAC INSERT LUX-DX M301","code_information":[{"code":"Px0000780679L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":10800.0,"discounted_cash":7560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LITHOVUE SYS GLOB STD DFLCTN M0067913500","code_information":[{"code":"Px0000780799L","type":"CDM"},{"code":"C1747","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":3244.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH SPYGLASS DISCVR T/A M00546780","code_information":[{"code":"Px0000781358L","type":"CDM"}],"standard_charges":[{"gross_charge":8278.0,"discounted_cash":5794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET CATH ROTAREX 6F 135CM 80237","code_information":[{"code":"Px0000781374L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":10204.0,"discounted_cash":7142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MAP SNSR ENABLED BI-D-REP DAVHDDF16REPROC","code_information":[{"code":"Px0000781567L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":4962.0,"discounted_cash":3473.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL TRANSEPT 71 8.0 CRV C1-REP RGEHF71C1RH","code_information":[{"code":"Px0000781574L","type":"CDM"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":978.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE SYNC SLCT SFT ST 215CM SSFT215STR","code_information":[{"code":"Px0000781621L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.63,"discounted_cash":1374.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE SYNC SLCT SFT ST 300CM SSFT300STR","code_information":[{"code":"Px0000781628L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MONITOR CARD SYS LIMQ II LNQ22SYS","code_information":[{"code":"Px0000782548L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":11812.0,"discounted_cash":8268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN DIL LG DIAMETER 120CM ATG120182","code_information":[{"code":"Px0000804938L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE REVASC SOLITAIRE X 3X20 SFR432010","code_information":[{"code":"Px0000806443L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13794.0,"discounted_cash":9655.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS ZOOM ICRC071137 ICRC071137","code_information":[{"code":"Px0000806635L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7218.0,"discounted_cash":5052.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET ACCESS .018IN 20CM 15CM 7F G04267","code_information":[{"code":"Px0000811444L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH INTRODUCER ONLY 1.4 FR","code_information":[{"code":"Px0000825735L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.27,"discounted_cash":317.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER ONLY 1.4 FR 30 CM POL","code_information":[{"code":"Px0000825736L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.56,"discounted_cash":339.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER ONLY 1.9 FR 30 CM POL P1PIC19C","code_information":[{"code":"Px0000825737L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.04,"discounted_cash":436.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELCTRD HEADBAND EEG CERIBELL DISP NTAP","code_information":[{"code":"Px0000827254L","type":"CDM"}],"standard_charges":[{"gross_charge":1865.0,"discounted_cash":1305.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELCTRD HEADBAND EEG CERIBELL DISP NTAP PEDIATR","code_information":[{"code":"Px0000827255L","type":"CDM"}],"standard_charges":[{"gross_charge":1865.0,"discounted_cash":1305.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL VASCULAR 20DIA 39 CM LENG 45752039","code_information":[{"code":"Px0000829144L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.71,"discounted_cash":2811.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACEMAKER CARDIAC 4.45CM 6.17C U228","code_information":[{"code":"Px0000829236L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":10848.0,"discounted_cash":7593.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAY PICC 4FR DUAL LUMEN MAX B S1294108D2","code_information":[{"code":"Px0000829379L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":887.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL TRANSEPT DIL QX FC 65CM 900304","code_information":[{"code":"Px0000831664L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1733.0,"discounted_cash":1213.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO SC 7F 23CM 22G 2.5CM PID7F23021SC","code_information":[{"code":"Px0000833166L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.24,"discounted_cash":191.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DEEP VEIN ABRE 14MM 100M AB9U14100090","code_information":[{"code":"Px0000833536L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DEEP VEIN ABRE 16MM 80MM AB9U16080090","code_information":[{"code":"Px0000833540L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT DEEP VEIN ABRE 16MM 100M AB9U16100090","code_information":[{"code":"Px0000833541L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WIRE PIGT 180 63 CM 8.5F 45D D0","code_information":[{"code":"Px0000834339L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.0,"discounted_cash":1496.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH KIT PERIVAC PIGTAIL US M004PERIVAC1P0","code_information":[{"code":"Px0000834572L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PICC DL POLY","code_information":[{"code":"Px0000837769L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.8,"discounted_cash":314.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH DRN RESLV 8.5F 14X5CM 17H (RBC-8-038) RBC8038","code_information":[{"code":"Px0000839994L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT FLOWTRIEVER SYSTEM FT-PPP","code_information":[{"code":"Px0000840658L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":25300.0,"discounted_cash":17710.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH TRANSEPT ML1 8.5FR 63CM FCL20101","code_information":[{"code":"Px0000841112L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.32,"discounted_cash":624.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEPARATOR 7D INDGO 90CM SEP7D","code_information":[{"code":"Px0000841117L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDGO 7D W/ TBNG CAT7DKIT","code_information":[{"code":"Px0000841118L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7856.0,"discounted_cash":5499.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SET EXT JEJU 16FR 22CM 8270162022","code_information":[{"code":"Px0000841367L","type":"CDM"}],"standard_charges":[{"gross_charge":1493.0,"discounted_cash":1045.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT ELECTRODE SURFACE ENSITESEK501","code_information":[{"code":"Px0000841808L","type":"CDM"}],"standard_charges":[{"gross_charge":4005.82,"discounted_cash":2804.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GRAFT HUM TISS ORTH PTCH 2X3CM NO1230 6SQCM","code_information":[{"code":"Px0000842265L","type":"CDM"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH REPERFUS RED 62S RED62SKIT","code_information":[{"code":"Px0000842861L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8007.0,"discounted_cash":5604.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERCLOSE PROSTYLE 1277303","code_information":[{"code":"Px0000842866L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.8,"discounted_cash":683.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUS RED 68 RED68","code_information":[{"code":"Px0000842885L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7218.0,"discounted_cash":5052.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MONITOR CARD 1 CM JOT DX 1.7 DM4500","code_information":[{"code":"Px0000842887L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":9611.0,"discounted_cash":6727.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICD COBALT DR DDPB3D1","code_information":[{"code":"Px0000847003L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18906.0,"discounted_cash":13234.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEFIBRILLATOR DUAL CHAMBER MRI DDPB3D4","code_information":[{"code":"Px0000847004L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18906.0,"discounted_cash":13234.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEFIBRILLATOR SINGLE CHAMBER MRI COMPATIBLE IMPLANT DVPB3D4","code_information":[{"code":"Px0000847006L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15672.0,"discounted_cash":10970.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D COBALT HF QUAD DTPB2Q1","code_information":[{"code":"Px0000847007L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":23779.0,"discounted_cash":16645.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D COBALT HF QUAD DTPB2QQ","code_information":[{"code":"Px0000847008L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24786.0,"discounted_cash":17350.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRT-D COBALT HF DTPB2D1","code_information":[{"code":"Px0000847009L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":23460.0,"discounted_cash":16422.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUSION RED 72 RED72","code_information":[{"code":"Px0000847032L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7218.0,"discounted_cash":5052.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT BILI WFLX UC 8X40MM M00574620","code_information":[{"code":"Px0000847189L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":4681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYSTEM VASC CLSR VASCADE 6-12 800612C10U","code_information":[{"code":"Px0000847484L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1065.0,"discounted_cash":745.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE REVASC SOLITAIRE X 3X40 SFR434010","code_information":[{"code":"Px0000847946L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13794.0,"discounted_cash":9655.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 3.25X12 PED2-325-12","code_information":[{"code":"Px0000867959L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":36906.0,"discounted_cash":25834.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 3.25X14 PED2-325-14","code_information":[{"code":"Px0000867960L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 3.50X10  PED2-350-10","code_information":[{"code":"Px0000867967L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":36906.0,"discounted_cash":25834.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 3.50X14 PED2-350-14","code_information":[{"code":"Px0000867969L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":36906.0,"discounted_cash":25834.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 3.50X16 PED235016","code_information":[{"code":"Px0000867970L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 3.75X14 PED237514","code_information":[{"code":"Px0000867978L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.00X16 PED240016","code_information":[{"code":"Px0000867988L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.00X30 PED240030","code_information":[{"code":"Px0000867992L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":37937.0,"discounted_cash":26555.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.25X12 PED242512","code_information":[{"code":"Px0000867995L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.25X14 PED242514","code_information":[{"code":"Px0000867996L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.25X16 PED242516","code_information":[{"code":"Px0000867997L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.25X30 PED242530","code_information":[{"code":"Px0000868001L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":39543.0,"discounted_cash":27680.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.50X12 PED245012","code_information":[{"code":"Px0000868004L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":36906.0,"discounted_cash":25834.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.50X14 PED245014","code_information":[{"code":"Px0000868005L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.50X18 PED245018","code_information":[{"code":"Px0000868007L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":36906.0,"discounted_cash":25834.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.50X25 PED245025","code_information":[{"code":"Px0000868009L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":37937.0,"discounted_cash":26555.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.50X35 PED245035","code_information":[{"code":"Px0000868011L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":40594.0,"discounted_cash":28415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.75X12 PED247512","code_information":[{"code":"Px0000868013L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.75X14 PED247514","code_information":[{"code":"Px0000868014L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.75X16 PED2-475-16","code_information":[{"code":"Px0000868015L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.75X20 PED247520","code_information":[{"code":"Px0000868017L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 4.75X35 PED2-475-35","code_information":[{"code":"Px0000868020L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":39543.0,"discounted_cash":27680.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5.00X12 PED250012","code_information":[{"code":"Px0000868022L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5.00X14","code_information":[{"code":"Px0000868023L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5.00X16 PED2-500-16","code_information":[{"code":"Px0000868024L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5.00X18 PED250018","code_information":[{"code":"Px0000868025L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5.00X20 PED2-500-20","code_information":[{"code":"Px0000868026L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35407.0,"discounted_cash":24784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5X25 PED2-500-25","code_information":[{"code":"Px0000868027L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":37937.0,"discounted_cash":26555.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5.00X30 PED250030","code_information":[{"code":"Px0000868028L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":40593.0,"discounted_cash":28415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBL PIP FLX ST 5.00X35 PED250035","code_information":[{"code":"Px0000868029L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":40593.0,"discounted_cash":28415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE TIGERTRIEVER .021D 32MM TRPP7155","code_information":[{"code":"Px0000868192L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":8008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE TIGERTRIEVER .017D TRPP7166","code_information":[{"code":"Px0000868193L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":8008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDIGO HTORQ 12MM 100CM LITNG12HTORQ100","code_information":[{"code":"Px0000868387L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":18595.0,"discounted_cash":13016.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDIGO HTORQ 12MM 115CM LITNG12HTORQ115","code_information":[{"code":"Px0000868388L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":17820.0,"discounted_cash":12474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDIGO XTORQ 12MM 115CM LITNG12XTORQ100","code_information":[{"code":"Px0000868389L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":17820.0,"discounted_cash":12474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH INDIGO XTORQ 7MM 130CM LITNG7XTORQ130","code_information":[{"code":"Px0000868390L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":14652.0,"discounted_cash":10256.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEPARATOR 7 INDGO 190CM SEP7","code_information":[{"code":"Px0000868420L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5068.0,"discounted_cash":3547.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEPARATOR 12 DST F/CAT 150CM SEP12","code_information":[{"code":"Px0000868421L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5722.0,"discounted_cash":4005.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANN HRT DL PROTEK DUO 31FR 5140-5131","code_information":[{"code":"Px0000871151L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35192.0,"discounted_cash":24634.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH RAD DX SIM2 5.5FR 130CM 105FSIM130","code_information":[{"code":"Px0000871450L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAD ACC 7FR 100CM 107F079100","code_information":[{"code":"Px0000871451L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":2667.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN DBC RANGER 6X150X150C H74939419601510","code_information":[{"code":"Px0000871499L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4331.0,"discounted_cash":3031.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH BLN DBC RANGER 6X200X150C H74939419602010","code_information":[{"code":"Px0000871501L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5664.0,"discounted_cash":3964.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BASKET RETRV SPYGLS DISCOVER M00542990","code_information":[{"code":"Px0000871928L","type":"CDM"}],"standard_charges":[{"gross_charge":1032.0,"discounted_cash":722.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAD ACC LNG 95CM 106F07195","code_information":[{"code":"Px0000872391L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.0,"discounted_cash":2668.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAD ACC LNG 100CM 106F071100","code_information":[{"code":"Px0000872392L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.0,"discounted_cash":2668.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH RAD ACC LNG 105CM 106F071105","code_information":[{"code":"Px0000872393L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.0,"discounted_cash":2668.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT FEED JEJU 14F 3X51CM 82301430","code_information":[{"code":"Px0000872789L","type":"CDM"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE FEED JEJU 22F 4.5X45CM 8270224545","code_information":[{"code":"Px0000872831L","type":"CDM"}],"standard_charges":[{"gross_charge":1493.0,"discounted_cash":1045.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER CLOTTRIEVER BOLD 42102","code_information":[{"code":"Px0000873641L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13500.0,"discounted_cash":9450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH ENDOAVF WAVELINQ 4FR WQ4300","code_information":[{"code":"Px0000873724L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":18480.0,"discounted_cash":12936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROBE TEMP ESOPH SENSITHERM STPROBE7","code_information":[{"code":"Px0000873896L","type":"CDM"}],"standard_charges":[{"gross_charge":2054.45,"discounted_cash":1438.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MAP GALAXY 3-3-3-3-3 F D160906","code_information":[{"code":"Px0000876232L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":7130.0,"discounted_cash":4991.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MAP GALAXY 3-3-3-3-3 D D160903","code_information":[{"code":"Px0000876234L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":6931.0,"discounted_cash":4851.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE M5P 4.0X60 M5PIVL4060","code_information":[{"code":"Px0000881437L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10281.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE M5P 5.0X60 M5PIVL6060","code_information":[{"code":"Px0000881441L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10281.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE M5P 6.5X60 M5PIVL6560","code_information":[{"code":"Px0000881442L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10281.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE M5P 7.0X60 M5PIVL7060","code_information":[{"code":"Px0000881443L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10281.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE M5P 8.0X60 M5PIVL8060","code_information":[{"code":"Px0000881444L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10281.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBING SUCT ASPIR MAX","code_information":[{"code":"Px0001000655L","type":"CDM"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":866.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATH REPERFUS RED 68S RED68SKIT","code_information":[{"code":"Px0001000656L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8533.0,"discounted_cash":5973.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH 4-POLR FREEZOR 2 5 2MM 207F1","code_information":[{"code":"Px0001000974L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3466.0,"discounted_cash":2426.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH MLT REACH 7FRX6MMX108CM 217F5","code_information":[{"code":"Px0001000979L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3796.0,"discounted_cash":2657.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NDL DIAG ACQCROSS QX 81CM 900309","code_information":[{"code":"Px0001002576L","type":"CDM"}],"standard_charges":[{"gross_charge":1817.0,"discounted_cash":1271.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH PACE DEL FEM AVEIR 105CM LSCD111","code_information":[{"code":"Px0001003119L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5408.0,"discounted_cash":3785.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACER VR AVEIR 19.5FRX38.5MM LSP112V","code_information":[{"code":"Px0001003122L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":16632.0,"discounted_cash":11642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THROMB 0.045INX144CM ICRC045144","code_information":[{"code":"Px0001003775L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7556.0,"discounted_cash":5289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THROMB 0.035INX158CM ICRC035158","code_information":[{"code":"Px0001003777L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5243.0,"discounted_cash":3670.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER THROMBECTOMY 0.055INX137CM ASPIRATION ICRC055137","code_information":[{"code":"Px0001003780L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7218.0,"discounted_cash":5052.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RETRV THRMB 0.013INX20.5MM ANPP7144","code_information":[{"code":"Px0001003782L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11276.0,"discounted_cash":7893.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBING THROMBECTOMY ASPIRATION ZOOM AFT117B","code_information":[{"code":"Px0001003785L","type":"CDM"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":854.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH LASER 16FRX50CM IVC FILTER REMOVAL CAVACLEAR 500-516","code_information":[{"code":"Px0001003984L","type":"CDM"},{"code":"C1603","type":"HCPCS"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 14MMX65CM PRES1465CPKPLT","code_information":[{"code":"Px0001004021L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB 2MMX6CM NON COATED PRESTIGE PLUS PRES0206CXPPLT","code_information":[{"code":"Px0001004022L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1706.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 3MMX20CM PRES0320CXPPLT","code_information":[{"code":"Px0001004027L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1898.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 4MMX10CM PRES0410CPKPLT","code_information":[{"code":"Px0001004028L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2556.0,"discounted_cash":1789.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 2MMX8CM PRES0208CXPPLT","code_information":[{"code":"Px0001004029L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1706.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRSTGE PLS PRES1065HPKPL","code_information":[{"code":"Px0001004035L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRSTGE PLS 8MMX65CM PRES0865CPKPLT","code_information":[{"code":"Px0001004036L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 3MMX10CM PRES0310CXPPLT","code_information":[{"code":"Px0001004041L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1706.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 2MMX12CM PRES0212CXPPLT","code_information":[{"code":"Px0001004042L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1898.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 2MMX4CM PRES0204CXPPLT","code_information":[{"code":"Px0001004045L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1706.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 10MMX65CM PRES1065CPKPLT","code_information":[{"code":"Px0001004047L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 20MMX65CM PRES2065CPKPLT","code_information":[{"code":"Px0001004050L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 10MMX45CM PRES1045CPKPLT","code_information":[{"code":"Px0001004053L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 12MMX65CM PRES1265CPKPLT","code_information":[{"code":"Px0001004057L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED PRESTIGE PLUS 4MMX20CM PRES0420CPKPLT","code_information":[{"code":"Px0001004062L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2711.0,"discounted_cash":1897.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRSTIE PLS COIL EMBOLIZATION PRES0620CPKPLT","code_information":[{"code":"Px0001004067L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1898.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED PRESTIGE PLUS 5MMX17CM PRES0517CPKPLT","code_information":[{"code":"Px0001004068L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1898.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 18MMX65CM PRES1865CPKPLT","code_information":[{"code":"Px0001004069L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED PRESTIGE PLUS PRES0510CPKPLT 5MMX10CM","code_information":[{"code":"Px0001004072L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2556.0,"discounted_cash":1789.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 6MMX50CM PRES0650CPKPLT","code_information":[{"code":"Px0001004077L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 4MMX13CM PRES0413CPKPLT","code_information":[{"code":"Px0001004080L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1898.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB 6MMX15CM PRSTGE PLS PRES0615CPKPLT","code_information":[{"code":"Px0001004081L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":2121.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 16MMX65CM PRES1665CPKPLT","code_information":[{"code":"Px0001004082L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 16MMX50CM PRES1650CPKPLT","code_information":[{"code":"Px0001004087L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 15MMX50CM PRES1550CPKPLT","code_information":[{"code":"Px0001004088L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 24MMX65CM PRES2465CPKPLT","code_information":[{"code":"Px0001004089L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 7MMX20CM COIL EMBOLIZATION PRES0720CPKPLT","code_information":[{"code":"Px0001004091L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1898.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 15MMX65CM PRES1565CPKPLT","code_information":[{"code":"Px0001004094L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED PRESTIGE PLUS 7MMX50CM PRES0750CPKPLT","code_information":[{"code":"Px0001004096L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRESTIGE PLUS 22MMX65CM PRES2265CPKPLT","code_information":[{"code":"Px0001004097L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB NON COATED PRESTIGE PLUS 18MMX50CM PRES1850CPKPLT","code_information":[{"code":"Px0001004098L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3466.0,"discounted_cash":2426.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EMB COIL PRESTIGE PLUS 9MMX65CM PRES0965CPKPLT","code_information":[{"code":"Px0001004099L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED PRESTIGE PLUS 6MMX35CM PRES0635CPKPLT","code_information":[{"code":"Px0001004100L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":2121.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED PRESTIGE PLUS 4MMX40CM PRES0440HPKPL","code_information":[{"code":"Px0001004105L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3307.0,"discounted_cash":2314.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL PRSTGE PLS PRES0540CPKPLT PRES0540CPKPLT","code_information":[{"code":"Px0001004108L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMB PRESTIGE PLUS 14MMX45CM PRES1445CPKPLT","code_information":[{"code":"Px0001004110L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONTROLLER DETACHMENT NON COATED ULTRA","code_information":[{"code":"Px0001004112L","type":"CDM"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":612.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED PRESTIGE PLUS 4MMX35CM PRES0435CPKPLT","code_information":[{"code":"Px0001004121L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3030.0,"discounted_cash":2121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KIT CATHETER IMPELLA 5.5 S2 1000100","code_information":[{"code":"Px0001005454L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":74900.0,"discounted_cash":52430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE BENCHMARK BMX 95CM BMX7F95","code_information":[{"code":"Px0001005467L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3046.0,"discounted_cash":2132.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE BENCHMARK BMX 105CM BMX7F105","code_information":[{"code":"Px0001005468L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3046.0,"discounted_cash":2132.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER THROMBECTOMY VENOUS OTW DUAL LUMEN INTHRILL 43102","code_information":[{"code":"Px0001007543L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":4681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH THROMBECTOMY VENOUS DUAL LUMEN INTHRILL 53101","code_information":[{"code":"Px0001007545L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5508.0,"discounted_cash":3855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GRAFT TISSUE SYNTH 10CC INJECT REGENERTVE BIO SUBS PRO-DENSE 87SR0100","code_information":[{"code":"Px0001007747L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9552.0,"discounted_cash":6686.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3944.0,"discounted_cash":2760.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER BALLOON PERIPHERAL GATEWAY 2.8FRX3X20MMX90CM M0032072220300","code_information":[{"code":"Px0001008354L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"discounted_cash":2250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THROMB ASPIR LTG FLASH LITNGFHT100BER","code_information":[{"code":"Px0001009025L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":24566.0,"discounted_cash":17196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THROMB 80CM ASP LIGHTNING FLASH LITNGFHT80BER","code_information":[{"code":"Px0001009256L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":24566.0,"discounted_cash":17196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH LIGHTNING FLASH 115CM LITNGFHT115BER","code_information":[{"code":"Px0001009413L","type":"CDM"}],"standard_charges":[{"gross_charge":25606.0,"discounted_cash":17924.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GLIDEPATH 7.5FRX8CM 5373080","code_information":[{"code":"Px0001010779L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.0,"discounted_cash":1099.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NONCOATED TARGET TETRA TG5412035 2.0MMX3.5CM TG5412035","code_information":[{"code":"Px0001012002L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3503.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 3.5MMX10.0CM COIL EMBOLIZATION NON COATED TG5413510","code_information":[{"code":"Px0001012004L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4086.25,"discounted_cash":2860.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 4.0MMX8.0CM TG5414080","code_information":[{"code":"Px0001012005L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5242.0,"discounted_cash":3669.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 3.0MMX6.0CM TG5413060","code_information":[{"code":"Px0001012009L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4086.25,"discounted_cash":2860.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 2.0MMX4.5CM TG5412045","code_information":[{"code":"Px0001012010L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4086.25,"discounted_cash":2860.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 2.5MMX6.0CM TG5412560","code_information":[{"code":"Px0001012011L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5242.0,"discounted_cash":3669.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 2.0MMX6.0CM COIL EMBOLIZATION NON COATED TG5412060","code_information":[{"code":"Px0001012012L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3503.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 3.0MMX4.5CM TG5413045","code_information":[{"code":"Px0001012013L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5242.0,"discounted_cash":3669.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 3.0MMX8.0CM TG5413080","code_information":[{"code":"Px0001012014L","type":"CDM"}],"standard_charges":[{"gross_charge":5242.0,"discounted_cash":3669.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED TARGET TETRA TG5411520 1.5MMX2.0CM","code_information":[{"code":"Px0001012016L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4086.25,"discounted_cash":2860.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 1.5MMX3.0CM TG5411530","code_information":[{"code":"Px0001012017L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5242.0,"discounted_cash":3669.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 4.0MMX10.0CM TG5414010","code_information":[{"code":"Px0001012019L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4086.25,"discounted_cash":2860.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 3.0MMX10.0CM TG5413010","code_information":[{"code":"Px0001012021L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5242.0,"discounted_cash":3669.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL TARGET TETRA 4.5MMX10.0CM TG5414510","code_information":[{"code":"Px0001012022L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4086.25,"discounted_cash":2860.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH REPERFUSION RED 43 160CM RED43160","code_information":[{"code":"Px0001014570L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7556.0,"discounted_cash":5289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEALANT HEMOSTATIC NON ANTIMICROBIAL FLOSEAL COLLGN 10ML ADS202110","code_information":[{"code":"Px0001016602L","type":"CDM"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":797.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACK SURG THROMBECTOMY CATH7 ASPIRATION TUBING 130CM TORQ+ LITNGBT7TQ130","code_information":[{"code":"Px0001016823L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":20939.0,"discounted_cash":14657.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACER SGL 0.75X4.45X6.13CM U225","code_information":[{"code":"Px0001017264L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":10631.0,"discounted_cash":7441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH GDE PERIPH AGILIS HISPRO DS3A001","code_information":[{"code":"Px0001017331L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE EMBOLIC PLUG CONFORMABLE SYRINGE DISP OBSIDIO M0013972101010","code_information":[{"code":"Px0001017438L","type":"CDM"}],"standard_charges":[{"gross_charge":10466.0,"discounted_cash":7326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER THROMBECTOMY REVCORE 80CM 44101","code_information":[{"code":"Px0001017458L","type":"CDM"}],"standard_charges":[{"gross_charge":17906.0,"discounted_cash":12534.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GWIRE STD PRFL .024 10CMX200CM A24200002","code_information":[{"code":"Px0001017806L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2470.0,"discounted_cash":1729.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER ABLATION TACTIFLEX SENSOR ENABLED 8FRX4MMX115CM ATFSEFJ","code_information":[{"code":"Px0001050118L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":11363.0,"discounted_cash":7954.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER ABLATION TACTIFLEX SENSOR ENABLED 8FRX4MMX115CM ATFSEDF","code_information":[{"code":"Px0001050126L","type":"CDM"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":11363.0,"discounted_cash":7954.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER REPERFUSION W/SENDIT TECH PENUMBRA TUBING RED 72 RED72SDKIT","code_information":[{"code":"Px0001060469L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13757.0,"discounted_cash":9629.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION DETACHABLE OPTIBLOCK 1.5MMX6CM OPTI0156BLK","code_information":[{"code":"Px0001061585L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11647.0,"discounted_cash":8152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION DETACHABLE OPTIBLOCK 1.5MMX8CM OPTI0158BLK","code_information":[{"code":"Px0001061588L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11647.0,"discounted_cash":8152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION DETACHABLE OPTIBLOCK 2.0MMX12CM OPTI0212BLK","code_information":[{"code":"Px0001061590L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11647.0,"discounted_cash":8152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION DETACHABLE OPTIBLOCK 2.0MMX6CM OPTI0206BLK","code_information":[{"code":"Px0001061597L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11647.0,"discounted_cash":8152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER MAPPING OPTRELL D142901","code_information":[{"code":"Px0001061660L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":7575.0,"discounted_cash":5302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACER SGL 0.75X4.45X6.13CM U225","code_information":[{"code":"Px0001062461L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":11276.0,"discounted_cash":7893.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MONITOR CARDIAC INSERTABLE LUX DX II M312","code_information":[{"code":"Px0001062669L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":11722.0,"discounted_cash":8205.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLUE EMBOLIZATION LIQUID PERIPHERAL VASCULATURE LAVA 34 2ML SLLES342","code_information":[{"code":"Px0001063532L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7113.0,"discounted_cash":4979.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLUE EMBOLIZATION LIQUID PERIPHERAL VASCULATURE LAVA 18 6ML SLLES186","code_information":[{"code":"Px0001063555L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16391.0,"discounted_cash":11473.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBING KIT CHANNEL ABLATION BONE ACCESS OSTEOCOOL OCN002HB","code_information":[{"code":"Px0001070445L","type":"CDM"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD PACEMAKER BIPOLAR ACTIVE FIXATION ULTIPACE 6FRX52CM LPA123152","code_information":[{"code":"Px0001071150L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":707.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD PACEMAKER BIPOLAR ACTIVE FIXATION ULTIPACE 6FRX58CM LPA123158","code_information":[{"code":"Px0001071190L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":707.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GENERATOR CARDIAC DEFIB CRT D DF1 CONNECTOR GALLANT HF CDHFA500T","code_information":[{"code":"Px0001071422L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24281.0,"discounted_cash":16996.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEADER CARDIAC DEFIBRILLATOR ICD DF1 CONNECTOR GALLANT VR CDVRA500T","code_information":[{"code":"Px0001071428L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15353.0,"discounted_cash":10747.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LEAD PACEMAKER BIPOLAR ACTIVE FIXATION ULTIPACE 6FRX46CM LPA123146","code_information":[{"code":"Px0001071468L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":707.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEADER CARDIAC DEFIB ICD DF1 GALLANT DR 14X51X73MM  CDDRA500T","code_information":[{"code":"Px0001071474L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18521.0,"discounted_cash":12964.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PERIPHERAL OVER THE WIRE ICAST STAINLESS STEEL 7X22MMX80CM 48722","code_information":[{"code":"Px0001073931L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8019.0,"discounted_cash":5613.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PERIPHERAL OTW ICAST STAINLESS STEEL 6X22MMX80CM 48622","code_information":[{"code":"Px0001073946L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8019.0,"discounted_cash":5613.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PERIPHERAL OVER THE WIRE ICAST STAINLESS STEEL 8X38MMX80CM 48838","code_information":[{"code":"Px0001073971L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8334.0,"discounted_cash":5833.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PERIPHERAL OVER THE WIRE ICAST STAINLESS STEEL 9X38MMX80CM 48938","code_information":[{"code":"Px0001073976L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8334.0,"discounted_cash":5833.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RECORDER CARDIAC ICM ASSERT IQ 3+ DM5300 3.1X9.4X46.5MM","code_information":[{"code":"Px0001073983L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":11512.0,"discounted_cash":8058.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RECORDER CARDIAC ICM ASSERT IQ EL+ 4.4X9.4X49MM DM5500","code_information":[{"code":"Px0001073984L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":11346.0,"discounted_cash":7942.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH CARDIOVASCULAR KIT STEERABLE FLEXCATH CONTOUR 12FRX20MM 12FCC20","code_information":[{"code":"Px0001074160L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3631.0,"discounted_cash":2541.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER ABLATION CORONARY PULSED FIELD M004PF41M401 NTAP 31 MM FARAWAVE","code_information":[{"code":"Px0001074263L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":22284.0,"discounted_cash":15598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SHEATH ABLATION CATHETER OVER THE FARADRIVE 13FRX74CM M004PF21M402","code_information":[{"code":"Px0001074313L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4249.0,"discounted_cash":2974.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER ABLATION CORONARY PULSED FIELD M004PF41M402 NTAP 35MM FARAWAVE","code_information":[{"code":"Px0001074319L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":22284.0,"discounted_cash":15598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GUIDEWIRE VASCULAR COLOSSUS ARISTOTLE 0.035INX200CM ACL200002","code_information":[{"code":"Px0001074399L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4331.0,"discounted_cash":3031.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELECTRODE ABLATION MONOPOLAR PULSED ALIYA GTI00024","code_information":[{"code":"Px0001078456L","type":"CDM"}],"standard_charges":[{"gross_charge":24789.0,"discounted_cash":17352.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEEDLE ABLATION MONOPOLAR PULSED ALIYA 19GAX20CM GTI00023","code_information":[{"code":"Px0001078457L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEVICE COOLING ESOPHAGEAL THERMAL REGULATION ENSOETM ECD02A SI ECD02A","code_information":[{"code":"Px0001080570L","type":"CDM"}],"standard_charges":[{"gross_charge":2725.0,"discounted_cash":1907.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER GUIDING PERIPHERAL ZOOM 0.088INX100CM ICTC088100S","code_information":[{"code":"Px0001081963L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":9436.0,"discounted_cash":6605.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER GUIDING PERIPHERAL ZOOM 0.088INX103CM ICTC088103R","code_information":[{"code":"Px0001081964L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":9436.0,"discounted_cash":6605.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SYSTEM PACEMAKER DUAL CHAMBER DR MRI MICRAAV2SYSTEM","code_information":[{"code":"Px0001085942L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":32225.0,"discounted_cash":22557.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATH THROMBECTOMY ASPIRATION LIGHTNING FLASH 100CM LITNGFHT100H1","code_information":[{"code":"Px0001087350L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":25606.0,"discounted_cash":17924.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RADIOPAQUE ADJUSTABLE THUMB SLIDER LF STRL SMARTCLAW FD066001 20MM","code_information":[{"code":"Px0001098830L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11647.0,"discounted_cash":8152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RADIOPAQUE ADJUSTABLE THUMB SLIDER LF STRL SMARTCLAW FD066002 32MM","code_information":[{"code":"Px0001098850L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11647.0,"discounted_cash":8152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE","code_information":[{"code":"Px00012010001","type":"CDM"}],"standard_charges":[{"gross_charge":2024.0,"discounted_cash":1416.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG W/ TELE","code_information":[{"code":"Px00012010009","type":"CDM"}],"standard_charges":[{"gross_charge":3096.0,"discounted_cash":2167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ISOLATION","code_information":[{"code":"Px00012010011","type":"CDM"}],"standard_charges":[{"gross_charge":2024.0,"discounted_cash":1416.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PEDIATRIC","code_information":[{"code":"Px00012310001","type":"CDM"}],"standard_charges":[{"gross_charge":2024.0,"discounted_cash":1416.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PEDIATRIC ISOLATION","code_information":[{"code":"Px00012310002","type":"CDM"}],"standard_charges":[{"gross_charge":2024.0,"discounted_cash":1416.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PSYCHIATRIC","code_information":[{"code":"Px00012410001","type":"CDM"}],"standard_charges":[{"gross_charge":4337.0,"discounted_cash":3035.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ONCOLOGY","code_information":[{"code":"Px00012710001","type":"CDM"}],"standard_charges":[{"gross_charge":4750.0,"discounted_cash":3325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS CMS/CA SNF LVL/WA IPF/WA LTAC CDM","code_information":[{"code":"Px00016910001","type":"CDM"}],"standard_charges":[{"gross_charge":2168.0,"discounted_cash":1517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B NURSERY ROUTINE CARE","code_information":[{"code":"Px00017010001","type":"CDM"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":1894.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 1","code_information":[{"code":"Px00017110001","type":"CDM"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":1894.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 2","code_information":[{"code":"Px00017210001","type":"CDM"}],"standard_charges":[{"gross_charge":12559.0,"discounted_cash":8791.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 3","code_information":[{"code":"Px00017310001","type":"CDM"}],"standard_charges":[{"gross_charge":19816.0,"discounted_cash":13871.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 4","code_information":[{"code":"Px00017410001","type":"CDM"}],"standard_charges":[{"gross_charge":27076.0,"discounted_cash":18953.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B NURSERY TRANSITIONAL CARE 0179","code_information":[{"code":"Px00017910001","type":"CDM"}],"standard_charges":[{"gross_charge":3179.0,"discounted_cash":2225.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS WA CDM","code_information":[{"code":"Px00019110002","type":"CDM"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTENSIVE CARE","code_information":[{"code":"Px00020010001","type":"CDM"}],"standard_charges":[{"gross_charge":6873.0,"discounted_cash":4811.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC R&B-ICU ISOLATION","code_information":[{"code":"Px00020010011","type":"CDM"}],"standard_charges":[{"gross_charge":6535.0,"discounted_cash":4574.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTENSIVE CARE PEDIATRIC","code_information":[{"code":"Px00020310001","type":"CDM"}],"standard_charges":[{"gross_charge":6989.0,"discounted_cash":4892.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTENSIVE CARE INTERMEDIATE","code_information":[{"code":"Px00020610001","type":"CDM"}],"standard_charges":[{"gross_charge":3416.0,"discounted_cash":2391.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTENSIVE CARE INTERMEDIATE W/TELEMETRY","code_information":[{"code":"Px00020610002","type":"CDM"}],"standard_charges":[{"gross_charge":3431.0,"discounted_cash":2401.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CORONARY CARE","code_information":[{"code":"Px00021010001","type":"CDM"}],"standard_charges":[{"gross_charge":6706.0,"discounted_cash":4694.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LIDOCAINE 2% JELLY","code_information":[{"code":"Px00025010027","type":"CDM"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIDOCAINE 2% JELLY UROJET","code_information":[{"code":"Px00025010028","type":"CDM"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00026010001","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":3785.0,"discounted_cash":2649.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00026010004","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":3785.0,"discounted_cash":2649.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":368.0,"discounted_cash":257.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD DRAW PICC OR NONIMPLANTED CENTRAL LINE CDM","code_information":[{"code":"Px00026010006","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":338.0,"discounted_cash":236.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00026010007","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV HYDRATION EACH ADDL HR CDM","code_information":[{"code":"Px00026010008","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":71.0,"discounted_cash":49.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00026010009","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":366.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":407.0,"discounted_cash":284.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV INFUSION EA ADDL HR CDM","code_information":[{"code":"Px00026010010","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV INFUSION SEQUENTIAL DRUG 1ST HR","code_information":[{"code":"Px00026010011","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV INFUSION CONCURRENT DRUG CDM","code_information":[{"code":"Px00026010012","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ATTEMPT PICC W/IMG W/RS&I 5 YR/>","code_information":[{"code":"Px00026010030","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":1117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3036.0,"discounted_cash":2125.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ATTEMPT MIDLINE 5 YR/>","code_information":[{"code":"Px00026010031","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1432.0,"discounted_cash":1002.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3292.0,"discounted_cash":2304.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC NITRIC OXIDE THERAPY HOURLY CDM","code_information":[{"code":"Px00027010142","type":"CDM"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROLACTA CREAM (PER ML)","code_information":[{"code":"Px00027010247","type":"CDM"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPTIME SHELL 272 Q4134","code_information":[{"code":"Px00027210121","type":"CDM"},{"code":"Q4134","type":"HCPCS"}],"standard_charges":[{"gross_charge":2244.0,"discounted_cash":1570.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROLACTA+ HR INFANT SUPP PER ML","code_information":[{"code":"Px00027210263","type":"CDM"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SO SHLDR CAP NO JOINTS CSTM","code_information":[{"code":"Px00027410235","type":"CDM"},{"code":"L3671","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":924.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EO  NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410236","type":"CDM"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EWHO RIGID NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410237","type":"CDM"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.0,"discounted_cash":759.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1085.0,"discounted_cash":759.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EWHFO RIGID NO JOINTS CSTM","code_information":[{"code":"Px00027410239","type":"CDM"},{"code":"L3765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.0,"discounted_cash":759.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":667.0,"discounted_cash":466.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WHO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410242","type":"CDM"},{"code":"L3905","type":"HCPCS"}],"standard_charges":[{"gross_charge":1808.0,"discounted_cash":1265.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HFO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410243","type":"CDM"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HAND ORTHOTIC -  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410244","type":"CDM"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410246","type":"CDM"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FO  W/JOINTS  CUSTOM","code_information":[{"code":"Px00027410247","type":"CDM"},{"code":"L3935","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC WHO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410269","type":"CDM"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":997.0,"discounted_cash":697.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000007","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SWEAT COLLECTION IONTOPHORESIS LAB","code_information":[{"code":"Px00030000013","type":"CDM"},{"code":"89230","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":213.0,"discounted_cash":149.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FAT STAIN FECES URINE/RESPIR SECRETIONS LAB","code_information":[{"code":"Px00030000014","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT LAB","code_information":[{"code":"Px00030000021","type":"CDM"},{"code":"89320","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":76.0,"discounted_cash":53.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD DRAW VENIPUNCTURE CDM","code_information":[{"code":"Px00030010004","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":24.0,"discounted_cash":16.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM","code_information":[{"code":"Px00030010009","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":24.0,"discounted_cash":16.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLLECTION CAPILLARY BLOOD SPECIMEN","code_information":[{"code":"Px00030010011","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":411.0,"discounted_cash":287.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE LAB","code_information":[{"code":"Px00030010015","type":"CDM"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.0,"discounted_cash":529.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SNRPN/UBE3A METHYLATION ANALYSIS CDM","code_information":[{"code":"Px00030010044","type":"CDM"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":971.0,"discounted_cash":679.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":954.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ARTERIAL CATHETER LINE SETUP AND INSERTION CDM","code_information":[{"code":"Px00030010051","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1206.0,"discounted_cash":844.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTOGEN M ARRAY COPY NO&SNP","code_information":[{"code":"Px00030010052","type":"CDM"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1841.0,"discounted_cash":1288.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLT3MT MUTATION DETECTION","code_information":[{"code":"Px00030010053","type":"CDM"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.0,"discounted_cash":1010.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PANCRATITIS LIO GSENE SEQ","code_information":[{"code":"Px00030010055","type":"CDM"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ROCKY MT SPOTTED FEVER IGG","code_information":[{"code":"Px00030010058","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLU A FLU B AND RSV BY PCR","code_information":[{"code":"Px00030010068","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ADENOVIRUS DNA QNT","code_information":[{"code":"Px00030010072","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES LAB","code_information":[{"code":"Px00030010082","type":"CDM"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":1154.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES CDM","code_information":[{"code":"Px00030010083","type":"CDM"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":867.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOLECULAR HLA-DPB1 TYPING","code_information":[{"code":"Px00030010084","type":"CDM"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":2211.0,"discounted_cash":1547.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA CDM","code_information":[{"code":"Px00030010085","type":"CDM"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":949.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOLECULAR HLA-DQA TYPING","code_information":[{"code":"Px00030010086","type":"CDM"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":1694.0,"discounted_cash":1185.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTI-DONOR HLA ANTIBODY TITERS","code_information":[{"code":"Px00030010087","type":"CDM"},{"code":"86805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1265.0,"discounted_cash":885.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM CDM","code_information":[{"code":"Px00030010099","type":"CDM"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET LAB","code_information":[{"code":"Px00030010191","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BACTERICIDAL LEVEL SERUM","code_information":[{"code":"Px00030010224","type":"CDM"},{"code":"87197","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":191.0,"discounted_cash":133.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030010228","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":631.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CXCR4 MOLELCULAR PATHOLOGY PROCEDURE LAB","code_information":[{"code":"Px00030010238","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1543.0,"discounted_cash":1080.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1057.0,"discounted_cash":739.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1807.0,"discounted_cash":1264.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BCR/ABL TRANSLOCATION MAJOR BREAKPOINT LAB","code_information":[{"code":"Px00030010266","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":359.0,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":546.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FACTOR V LEIDEN GENE ANALYSIS","code_information":[{"code":"Px00030010272","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYSTIC FIBROSIS GENE ANALYSIS","code_information":[{"code":"Px00030010276","type":"CDM"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGFR REFLEX SEQUENCING","code_information":[{"code":"Px00030010290","type":"CDM"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1774.0,"discounted_cash":1241.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IGK GENE REARRANGE B CELL CLON LAB","code_information":[{"code":"Px00030010291","type":"CDM"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RETT SYDROME MECP2 DNA ANAL","code_information":[{"code":"Px00030010294","type":"CDM"},{"code":"81302","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.0,"discounted_cash":1093.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AGGLUTININS FEBRILE EACH ANTIGEN LAB","code_information":[{"code":"Px00030010401","type":"CDM"},{"code":"86000","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES CDM","code_information":[{"code":"Px00030010413","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM","code_information":[{"code":"Px00030010421","type":"CDM"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH CDM","code_information":[{"code":"Px00030010427","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-1-ESTERASE INHIB FUNC(ARUP)","code_information":[{"code":"Px00030010431","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT CDM","code_information":[{"code":"Px00030010433","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CCP ANTIBODY","code_information":[{"code":"Px00030010438","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEOXYRIBONUCLEASE ANTIBODY","code_information":[{"code":"Px00030010447","type":"CDM"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - MISC","code_information":[{"code":"Px00030010450","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - PURKINJE","code_information":[{"code":"Px00030010451","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN MAG AB IGM","code_information":[{"code":"Px00030010454","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010472","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":238.0,"discounted_cash":166.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - MITOCHONDRIAL","code_information":[{"code":"Px00030010473","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030010475","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN AB","code_information":[{"code":"Px00030010478","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":183.0,"discounted_cash":128.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030010480","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 CDM","code_information":[{"code":"Px00030010492","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":409.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":238.0,"discounted_cash":166.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN AB","code_information":[{"code":"Px00030010495","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT ANTIBODY TITER","code_information":[{"code":"Px00030010512","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":351.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 CDM","code_information":[{"code":"Px00030010554","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":409.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":238.0,"discounted_cash":166.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR CA 15-3 CA 27.29","code_information":[{"code":"Px00030010556","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":409.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":238.0,"discounted_cash":166.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR CA 19-9","code_information":[{"code":"Px00030010558","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":238.0,"discounted_cash":166.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM","code_information":[{"code":"Px00030010560","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":238.0,"discounted_cash":166.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010567","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION OUCHTERLONY - GEL DIFFUSION","code_information":[{"code":"Px00030010585","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNE COMPLEX ASSAY CDM","code_information":[{"code":"Px00030010589","type":"CDM"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":191.0,"discounted_cash":133.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM","code_information":[{"code":"Px00030010599","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":256.0,"discounted_cash":179.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS CDM","code_information":[{"code":"Px00030010604","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF","code_information":[{"code":"Px00030010605","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - FLUIDS","code_information":[{"code":"Px00030010608","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INHIBIN A CDM","code_information":[{"code":"Px00030010612","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSULIN ANTIBODIES CDM","code_information":[{"code":"Px00030010617","type":"CDM"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISLET CELL ANTIBODY IGG(ARUP)","code_information":[{"code":"Px00030010621","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":200.0,"discounted_cash":140.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00030010623","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1432.0,"discounted_cash":1002.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CELL FUNCTION ASSAY W/STIM","code_information":[{"code":"Px00030010631","type":"CDM"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1736.0,"discounted_cash":1215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1545.0,"discounted_cash":1081.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC B CELLS TOTAL COUNT","code_information":[{"code":"Px00030010637","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NK CELLS TOTAL COUNT","code_information":[{"code":"Px00030010641","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T CELL ABSOLUTE COUNT/RATIO","code_information":[{"code":"Px00030010648","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT/RATIO - HELPER SUPPRESSOR","code_information":[{"code":"Px00030010649","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT","code_information":[{"code":"Px00030010657","type":"CDM"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010660","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010661","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSOMAL ANTIBODY","code_information":[{"code":"Px00030010663","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SKIN TEST CANDIDA","code_information":[{"code":"Px00030010676","type":"CDM"},{"code":"86485","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY BORDETELLA CDM","code_information":[{"code":"Px00030010682","type":"CDM"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SKIN TEST TUBERCULOSIS INTRADERMAL CDM","code_information":[{"code":"Px00030010684","type":"CDM"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BARTONELLA HENSELAE IGM (PANL)","code_information":[{"code":"Px00030010700","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":119.0,"discounted_cash":83.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLASTOMYCES ANTIBODY","code_information":[{"code":"Px00030010706","type":"CDM"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BARTONELLA ANTIBODY - HENSELAE","code_information":[{"code":"Px00030010711","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":119.0,"discounted_cash":83.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LYME DISEASE ANTIBODY - CSF","code_information":[{"code":"Px00030010727","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY","code_information":[{"code":"Px00030010731","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":197.0,"discounted_cash":137.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY BORRELIA RELAPSING FEVER CDM","code_information":[{"code":"Px00030010733","type":"CDM"},{"code":"86619","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":153.0,"discounted_cash":107.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER CDM","code_information":[{"code":"Px00030010743","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY CRYPTOCOCCUS CDM","code_information":[{"code":"Px00030010747","type":"CDM"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV CDM","code_information":[{"code":"Px00030010751","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CMV ANTIBODY","code_information":[{"code":"Px00030010753","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CMV ANTIBODY-MISC","code_information":[{"code":"Px00030010759","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM CDM","code_information":[{"code":"Px00030010764","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":195.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CMV ANTIBODY IGM","code_information":[{"code":"Px00030010765","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":195.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EPSTEIN-BARR ANTIBODY EARLY ANTIGEN","code_information":[{"code":"Px00030010809","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN","code_information":[{"code":"Px00030010814","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":175.0,"discounted_cash":122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID","code_information":[{"code":"Px00030010822","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID IGG","code_information":[{"code":"Px00030010823","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID IGM","code_information":[{"code":"Px00030010824","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - AB TO VCA IGM","code_information":[{"code":"Px00030010830","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY FRANCISELLA TULARENSIS CDM","code_information":[{"code":"Px00030010836","type":"CDM"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FRANCISELLA TULARENSIS - SEROLOGY","code_information":[{"code":"Px00030010837","type":"CDM"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HELICOBACTER PYLORI CDM","code_information":[{"code":"Px00030010843","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HELICOBACTER PYLORI CDM","code_information":[{"code":"Px00030010844","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HELICOBACTER PYLORI","code_information":[{"code":"Px00030010846","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST CDM","code_information":[{"code":"Px00030010869","type":"CDM"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HEP DELTA AGENT CDM","code_information":[{"code":"Px00030010872","type":"CDM"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":199.0,"discounted_cash":139.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010875","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010878","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HISTOPLASMA","code_information":[{"code":"Px00030010885","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 CDM","code_information":[{"code":"Px00030010889","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEP B CORE IGM ANTIBODY","code_information":[{"code":"Px00030010892","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY PARVOVIRUS CDM","code_information":[{"code":"Px00030010894","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 CDM","code_information":[{"code":"Px00030010897","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HERPES SIMPLEX TYPE 2","code_information":[{"code":"Px00030010903","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG","code_information":[{"code":"Px00030010906","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 CDM","code_information":[{"code":"Px00030010910","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 CDM","code_information":[{"code":"Px00030010911","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HISTOPLASMA CDM","code_information":[{"code":"Px00030010914","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":98.0,"discounted_cash":68.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HIV- 2","code_information":[{"code":"Px00030010922","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010926","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS BE ANTIBODY HBEAB CDM","code_information":[{"code":"Px00030010928","type":"CDM"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":134.0,"discounted_cash":93.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010931","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEGIONELLA ANTIBODY","code_information":[{"code":"Px00030010936","type":"CDM"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":175.0,"discounted_cash":122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEPTOSPIRA ANTIBODY","code_information":[{"code":"Px00030010939","type":"CDM"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYCOPLASMA IGM (PANL)","code_information":[{"code":"Px00030010944","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PARVOVIRUS ANTIBODY - AB IGG","code_information":[{"code":"Px00030010957","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030010970","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TOXOPLASMA ANTIBODY","code_information":[{"code":"Px00030010982","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TOXOPLASMA CDM","code_information":[{"code":"Px00030010984","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM CDM","code_information":[{"code":"Px00030010990","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030010996","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - IGG","code_information":[{"code":"Px00030011003","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011004","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011008","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011011","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - AB","code_information":[{"code":"Px00030011012","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY SCREEN","code_information":[{"code":"Px00030011019","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":183.0,"discounted_cash":128.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES","code_information":[{"code":"Px00030011023","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HLA TYPING A B OR C SINGLE ANTIGEN","code_information":[{"code":"Px00030011030","type":"CDM"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":298.0,"discounted_cash":208.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HLA TYPING A/B/C SINGLE ANTIGEN CDM","code_information":[{"code":"Px00030011031","type":"CDM"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":298.0,"discounted_cash":208.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOLOGY PROCEDURE","code_information":[{"code":"Px00030011035","type":"CDM"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":345.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY CDM","code_information":[{"code":"Px00030011045","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ CDM","code_information":[{"code":"Px00030011056","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DIRECT COOMBS","code_information":[{"code":"Px00030011070","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER LAB","code_information":[{"code":"Px00030011079","type":"CDM"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO LAB","code_information":[{"code":"Px00030011083","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011098","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":80.0,"discounted_cash":56.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS - PHENOTYPE","code_information":[{"code":"Px00030011112","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS","code_information":[{"code":"Px00030011114","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS - RBC OTHER EA","code_information":[{"code":"Px00030011116","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION CDM","code_information":[{"code":"Px00030011117","type":"CDM"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN LAB","code_information":[{"code":"Px00030011123","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ELECTRONIC LAB","code_information":[{"code":"Px00030011125","type":"CDM"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH LAB","code_information":[{"code":"Px00030011127","type":"CDM"},{"code":"86940","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH LAB","code_information":[{"code":"Px00030011132","type":"CDM"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.08,"discounted_cash":359.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA LAB","code_information":[{"code":"Px00030011135","type":"CDM"},{"code":"86977","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.08,"discounted_cash":359.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RBC PRETREATMENT SERUM - EACH CELL","code_information":[{"code":"Px00030011136","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC PRETREATMENT SERUM - ABSORPTION","code_information":[{"code":"Px00030011137","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIMEN CONCENTRATION","code_information":[{"code":"Px00030011141","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS CDM","code_information":[{"code":"Px00030011147","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTR BACTERIA EXCEPT BLOOD","code_information":[{"code":"Px00030011159","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE MYCOPLASMA ANY SOURCE CDM","code_information":[{"code":"Px00030011166","type":"CDM"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":137.0,"discounted_cash":95.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLAMYDIA CULTURE","code_information":[{"code":"Px00030011169","type":"CDM"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYCOBACTERIC IDENTIFICATION","code_information":[{"code":"Px00030011172","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM CDM","code_information":[{"code":"Px00030011175","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM CDM","code_information":[{"code":"Px00030011179","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":66.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","code_information":[{"code":"Px00030011185","type":"CDM"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":298.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MACROSCOPIC EXAM PARASITE","code_information":[{"code":"Px00030011197","type":"CDM"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OVA AND PARASITES SMEARS","code_information":[{"code":"Px00030011200","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":114.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROBE SUSCEPT MACROBROTH - AFB SENS  EA AGENT","code_information":[{"code":"Px00030011216","type":"CDM"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAI","code_information":[{"code":"Px00030011226","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":60.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAIN - SMEAR PRI","code_information":[{"code":"Px00030011232","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAIN- FUNGUS","code_information":[{"code":"Px00030011244","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030011248","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030011249","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMEAR WET MOUNT SALINE/INK - KOH EXAM","code_information":[{"code":"Px00030011260","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011261","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT CDM","code_information":[{"code":"Px00030011273","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY TOXIN OR ANTITOXIN","code_information":[{"code":"Px00030011274","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":251.0,"discounted_cash":175.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VIRUS INOCULATION TISSUE","code_information":[{"code":"Px00030011280","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":330.0,"discounted_cash":231.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VIRUS INOCULATION TISSUE - VIRAL CULTURE","code_information":[{"code":"Px00030011289","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":330.0,"discounted_cash":231.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VIRUS INOCULATE TISSUE ADDL","code_information":[{"code":"Px00030011295","type":"CDM"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":255.0,"discounted_cash":178.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VIRUS INOCULATION SHELL VIA","code_information":[{"code":"Px00030011304","type":"CDM"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":242.0,"discounted_cash":169.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC CDM","code_information":[{"code":"Px00030011308","type":"CDM"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":427.0,"discounted_cash":298.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ADENOVIRUS INFECTIOUS AGENT","code_information":[{"code":"Px00030011309","type":"CDM"},{"code":"87260","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY CDM","code_information":[{"code":"Px00030011313","type":"CDM"},{"code":"87271","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INFLUENZA B AG IF","code_information":[{"code":"Px00030011318","type":"CDM"},{"code":"87275","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INFLUENZA A AG IF","code_information":[{"code":"Px00030011321","type":"CDM"},{"code":"87276","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEGION PNEUMOPHILIA AG IF","code_information":[{"code":"Px00030011323","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PARAINFLUENZA AG IF","code_information":[{"code":"Px00030011326","type":"CDM"},{"code":"87279","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAADI RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011328","type":"CDM"},{"code":"87280","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAADI PNEUMOCUSTIS CARINII CDM","code_information":[{"code":"Px00030011331","type":"CDM"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":494.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PNEUMOCYSTIS-DIRECT FA","code_information":[{"code":"Px00030011332","type":"CDM"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":567.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VARICELLA ZOSTER AG IF","code_information":[{"code":"Px00030011337","type":"CDM"},{"code":"87290","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VARICELLA ZOSTER AG IF - BY IFA","code_information":[{"code":"Px00030011339","type":"CDM"},{"code":"87290","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY DETECTION NOS IF","code_information":[{"code":"Px00030011343","type":"CDM"},{"code":"87299","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AG DETECTION POLYVAL IF - RESP POOL DIRECT","code_information":[{"code":"Px00030011346","type":"CDM"},{"code":"87300","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AG DETECTION POLYVAL IF - INFECTIOUS AGENT","code_information":[{"code":"Px00030011347","type":"CDM"},{"code":"87300","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYPTOCOCCUS NEOFORM AG EIA","code_information":[{"code":"Px00030011352","type":"CDM"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM AG EIA","code_information":[{"code":"Px00030011355","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG","code_information":[{"code":"Px00030011359","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING GLC/HPLC","code_information":[{"code":"Px00030011378","type":"CDM"},{"code":"87143","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":159.0,"discounted_cash":111.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES SCREEN - REFLEXIVE","code_information":[{"code":"Px00030011393","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS BE ANTIGEN CDM","code_information":[{"code":"Px00030011397","type":"CDM"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":147.0,"discounted_cash":102.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM CDM","code_information":[{"code":"Px00030011405","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":380.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC STREP TEST RAPID","code_information":[{"code":"Px00030011409","type":"CDM"},{"code":"87430","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BAL-OIL RED O STAIN","code_information":[{"code":"Px00030011423","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL TRANSCUTANEOUS CDM","code_information":[{"code":"Px00030011424","type":"CDM"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA BK VIRUS QUANTIFICATION EACH ORGANISM CDM","code_information":[{"code":"Px00030011426","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BK VIRUS QUANT PCR (ARUP)","code_information":[{"code":"Px00030011427","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":652.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BK VIRUS QUANT PCR URINE","code_information":[{"code":"Px00030011428","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":652.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BK VIRUS URINE VIRACOR","code_information":[{"code":"Px00030011429","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"discounted_cash":640.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030011479","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN","code_information":[{"code":"Px00030011497","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN DIPTHERIA CDM","code_information":[{"code":"Px00030011501","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COCCI AB  IGG (EIA) (PANL)","code_information":[{"code":"Px00030011506","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":134.0,"discounted_cash":93.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COCCI AB (ID) (PANL)","code_information":[{"code":"Px00030011507","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":134.0,"discounted_cash":93.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030011511","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":165.0,"discounted_cash":115.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POOLING PLATELETS/OTHER BLOOD PRODUCTS LAB","code_information":[{"code":"Px00030011514","type":"CDM"},{"code":"86965","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT","code_information":[{"code":"Px00030011519","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL","code_information":[{"code":"Px00030011520","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL CSF","code_information":[{"code":"Px00030011521","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BORDETELLA PERTUSSIS PCR","code_information":[{"code":"Px00030011530","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":881.0,"discounted_cash":616.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ CDM","code_information":[{"code":"Px00030011540","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CCD3 FLOW","code_information":[{"code":"Px00030011542","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD10 FLOW","code_information":[{"code":"Px00030011543","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD117 FLOW","code_information":[{"code":"Px00030011544","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD11B FLOW","code_information":[{"code":"Px00030011545","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD13 FLOW","code_information":[{"code":"Px00030011546","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD138 FLOW","code_information":[{"code":"Px00030011547","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD14 FLOW","code_information":[{"code":"Px00030011548","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD14MO2 FLOW","code_information":[{"code":"Px00030011549","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD15 FLOW","code_information":[{"code":"Px00030011551","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD19 FLOW","code_information":[{"code":"Px00030011552","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD20 FLOW","code_information":[{"code":"Px00030011553","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD25 FLOW","code_information":[{"code":"Px00030011555","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD33 FLOW","code_information":[{"code":"Px00030011556","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD34 FLOW","code_information":[{"code":"Px00030011557","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD38 FLOW","code_information":[{"code":"Px00030011559","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD41 FLOW","code_information":[{"code":"Px00030011562","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD56 FLOW","code_information":[{"code":"Px00030011563","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD57 FLOW","code_information":[{"code":"Px00030011564","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD64 FLOW","code_information":[{"code":"Px00030011565","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD7 FLOW","code_information":[{"code":"Px00030011566","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD8 FLOW","code_information":[{"code":"Px00030011567","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHLAMYDIA PNEUM DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030011570","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLAMYDIA TRACHOMATIS PCR","code_information":[{"code":"Px00030011572","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":383.0,"discounted_cash":268.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE","code_information":[{"code":"Px00030011574","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME ANALYSIS 45 CELLS MOSAICISM","code_information":[{"code":"Px00030011575","type":"CDM"},{"code":"88263","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1119.0,"discounted_cash":783.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING CDM","code_information":[{"code":"Px00030011578","type":"CDM"},{"code":"88261","type":"HCPCS"}],"standard_charges":[{"gross_charge":2968.0,"discounted_cash":2077.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1314.0,"discounted_cash":919.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA CYTOMEGALOVIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030011582","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SWEAT COLLECTION IONTOPHORESIS CDM","code_information":[{"code":"Px00030011583","type":"CDM"},{"code":"89230","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":213.0,"discounted_cash":149.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DR-HLA FLOW","code_information":[{"code":"Px00030011598","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EIA ANTIGEN DETECTION","code_information":[{"code":"Px00030011608","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011609","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011610","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EPSTEIN BARR VIRUS BY PCR","code_information":[{"code":"Px00030011612","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA EPSTEIN BARR QUANTIFICATION EA ORG CDM","code_information":[{"code":"Px00030011613","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":429.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXAM RETRIEVED TISSUE MOLECULAR ANALYSIS","code_information":[{"code":"Px00030011615","type":"CDM"},{"code":"88363","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FAT STAIN FECES URINE/RESPIR SECRETIONS CDM","code_information":[{"code":"Px00030011616","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FERN TEST","code_information":[{"code":"Px00030011617","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":297.0,"discounted_cash":207.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ CDM","code_information":[{"code":"Px00030011637","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLYCO A FLOW","code_information":[{"code":"Px00030011640","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM","code_information":[{"code":"Px00030011653","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS C RNA BY BRANCH DNA","code_information":[{"code":"Px00030011654","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS C RNA QUANTIFICATION","code_information":[{"code":"Px00030011655","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HIV VIRAL LOAD","code_information":[{"code":"Px00030011661","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOPHENOTYPING 2ND ANTIBODY","code_information":[{"code":"Px00030011678","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOPHENOTYPING ONE ANTIBODY","code_information":[{"code":"Px00030011688","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INF AGENT BY NUCLEIC ACID QUAN","code_information":[{"code":"Px00030011690","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT ANTIGEN DETECTION","code_information":[{"code":"Px00030011692","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION AMPLIFIED PROBE","code_information":[{"code":"Px00030011693","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INHIBIN A CDM","code_information":[{"code":"Px00030011698","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISH ANALYSZE 3-5 CELLS","code_information":[{"code":"Px00030011699","type":"CDM"},{"code":"88272","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":201.0,"discounted_cash":140.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":859.0,"discounted_cash":601.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LAMBDA FLOW","code_information":[{"code":"Px00030011702","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011703","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011710","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MATURATION INDEX","code_information":[{"code":"Px00030011713","type":"CDM"},{"code":"88155","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":81.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC METABOLIC SCRN NEWBORN","code_information":[{"code":"Px00030011718","type":"CDM"},{"code":"S3620","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP A LAB","code_information":[{"code":"Px00030011741","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY ELUTION RBC EACH ELUTION LAB","code_information":[{"code":"Px00030011742","type":"CDM"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":179.0,"discounted_cash":125.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011749","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL STAIN GROUP 2  IRON","code_information":[{"code":"Px00030011751","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM CDM","code_information":[{"code":"Px00030011752","type":"CDM"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS  W/ HUHNER","code_information":[{"code":"Px00030011753","type":"CDM"},{"code":"89300","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SHIGATOXIN","code_information":[{"code":"Px00030011754","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011759","type":"CDM"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC STREP PNEUMO ANTIGEN","code_information":[{"code":"Px00030011761","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011762","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEP A ANTIBODY IGM AB","code_information":[{"code":"Px00030011859","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030011861","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":492.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - ANCA TITER","code_information":[{"code":"Px00030011864","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HYPERSENS PNEUMO II (PANEL)","code_information":[{"code":"Px00030011866","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":233.0,"discounted_cash":163.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00030011868","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS CDM","code_information":[{"code":"Px00030011871","type":"CDM"},{"code":"86353","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":559.0,"discounted_cash":391.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EBV AB TO EARLY (D) AG IGG","code_information":[{"code":"Px00030011882","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS - TYPING UNIT","code_information":[{"code":"Px00030011888","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":80.0,"discounted_cash":56.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COCCI AB  IGM (EIA) (PANL)","code_information":[{"code":"Px00030011913","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":134.0,"discounted_cash":93.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM","code_information":[{"code":"Px00030011916","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KAPPA FLOW","code_information":[{"code":"Px00030011921","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS USING STRICT MORPHOLOGIC CRITERIA","code_information":[{"code":"Px00030011927","type":"CDM"},{"code":"89322","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEMEN ALYS MOTILITY&CNT X W/HUHNER TST CDM","code_information":[{"code":"Px00030011929","type":"CDM"},{"code":"89310","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":46.0,"discounted_cash":32.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE LAB","code_information":[{"code":"Px00030011963","type":"CDM"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER - GENITAL TRACT","code_information":[{"code":"Px00030011967","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CATHETERIZE FOR URINE SPECIMEN P9612","code_information":[{"code":"Px00030011972","type":"CDM"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR V LEIDEN PCR","code_information":[{"code":"Px00030011976","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FACTOR II PROTHROMBIN GENE MUTAT","code_information":[{"code":"Px00030011977","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PH  URINE QUALITATIVE","code_information":[{"code":"Px00030012009","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHROMOSOME MICROARRAY SNP","code_information":[{"code":"Px00030012011","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":2072.0,"discounted_cash":1450.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":726.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONNEXIN 26 (GJB2) ANAL B26UP","code_information":[{"code":"Px00030012017","type":"CDM"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":481.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PANCREATITIS IDIO MOPATH UNL","code_information":[{"code":"Px00030012020","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":4119.0,"discounted_cash":2883.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALBUMIN CSF/SERUM","code_information":[{"code":"Px00030012021","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CORTISOL 3 SAMPLES","code_information":[{"code":"Px00030012028","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00030012034","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030012037","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOGLOBIN/THAL SCREEN","code_information":[{"code":"Px00030012040","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GANGLIOSIDE ABS IGG AND IGM","code_information":[{"code":"Px00030012041","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TSH RECEPTOR ABY","code_information":[{"code":"Px00030012043","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VOLTAGE-GATED K CHANNEL AB","code_information":[{"code":"Px00030012045","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ADAMTS 13 REFLEX INHIBITOR","code_information":[{"code":"Px00030012046","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELSIA-ASCAS OMPC CBIRI PANCA","code_information":[{"code":"Px00030012047","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTERLEUKIN 2 RECEP SOL MAFD","code_information":[{"code":"Px00030012049","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTERLEUKIN 6 BY MAFD","code_information":[{"code":"Px00030012050","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTERLUKIN 10","code_information":[{"code":"Px00030012051","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RHEUMATOID FACTOR CDM","code_information":[{"code":"Px00030012052","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ADENOSINE DEAMINASE CSF/FLUID","code_information":[{"code":"Px00030012065","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DIFFERENTIAL MANUAL","code_information":[{"code":"Px00030012071","type":"CDM"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RBC MORPH","code_information":[{"code":"Px00030012072","type":"CDM"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOGLOBIN SURGERY","code_information":[{"code":"Px00030012073","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RETICULOCYTE COUNT-AUTO","code_information":[{"code":"Px00030012075","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACT BY PERFUSIONIST","code_information":[{"code":"Px00030012082","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACTIVATED CLOTTING TIME SURGERY","code_information":[{"code":"Px00030012083","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TEG 2","code_information":[{"code":"Px00030012084","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TEG 1","code_information":[{"code":"Px00030012085","type":"CDM"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T ADP SECRETION WBPAGG TECH","code_information":[{"code":"Px00030012091","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T COLLAGEN LOW AGG WBPAGG TECH","code_information":[{"code":"Px00030012096","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T COLLAGEN LOW SEC WBPAGG TECH","code_information":[{"code":"Px00030012097","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T RISTOCETIN HIGH AGG WBPAGG TEC","code_information":[{"code":"Px00030012098","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T RISTOCETIN LOW AGG WBPAGG TECH","code_information":[{"code":"Px00030012099","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T THROMBIN SECRETION WBPAGG TECH","code_information":[{"code":"Px00030012100","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRVVT (LUP INH)","code_information":[{"code":"Px00030012104","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TT PT/PS MIX","code_information":[{"code":"Px00030012106","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TT PT/CT MIX","code_information":[{"code":"Px00030012107","type":"CDM"},{"code":"85675","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PTT POST 60 MIN INCUBATION","code_information":[{"code":"Px00030012108","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTI-NEUTROPHIL ANTIBODY","code_information":[{"code":"Px00030012114","type":"CDM"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":578.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM","code_information":[{"code":"Px00030012117","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PHOSPHOLIPID ANTIBODY IGA","code_information":[{"code":"Px00030012118","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PHOSPHOLIPID ANTIBODY IGM","code_information":[{"code":"Px00030012119","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC JO 1 AUTOANTIBODY","code_information":[{"code":"Px00030012121","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RNP AUTOANTIBODY","code_information":[{"code":"Px00030012123","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SCL-70 AB - LUPUS","code_information":[{"code":"Px00030012124","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMITH AUTOANTIBODY","code_information":[{"code":"Px00030012125","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC SSA (RO) AUTOANTIBODY","code_information":[{"code":"Px00030012127","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SSB (LA) AUTOANTIBODY","code_information":[{"code":"Px00030012128","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HU  YO  RI ANTIBODIES","code_information":[{"code":"Px00030012130","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PARIETAL CELL AB (A G M)","code_information":[{"code":"Px00030012132","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANCA TITER","code_information":[{"code":"Px00030012134","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HU YO RI ABY TITER","code_information":[{"code":"Px00030012138","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEURON SPECIFIC ENOLASE","code_information":[{"code":"Px00030012141","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEMOCOCCAL SEROTYPE 4  IGG","code_information":[{"code":"Px00030012142","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEMOCOCCAL SEROTYPE 9V  IGG","code_information":[{"code":"Px00030012143","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYP 23F  IGG","code_information":[{"code":"Px00030012144","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 1  IGG","code_information":[{"code":"Px00030012145","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 12F  IGG","code_information":[{"code":"Px00030012146","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 14  IGG","code_information":[{"code":"Px00030012147","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 18C  IGG","code_information":[{"code":"Px00030012148","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 19F  IGG","code_information":[{"code":"Px00030012149","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 3  IGG","code_information":[{"code":"Px00030012150","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 5  IGG","code_information":[{"code":"Px00030012151","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 6B  IGG","code_information":[{"code":"Px00030012152","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 7F  IGG","code_information":[{"code":"Px00030012153","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 8  IGG","code_information":[{"code":"Px00030012154","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 9N  IGG","code_information":[{"code":"Px00030012155","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HYPSENS PNEUMO EXT  IMMUNODIFF","code_information":[{"code":"Px00030012156","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOFIXATION ADD-ON","code_information":[{"code":"Px00030012157","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD19 FLOW STANDALONE TEST","code_information":[{"code":"Px00030012159","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD3 FLOW STANDALONE TEST","code_information":[{"code":"Px00030012160","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD4 CD8/RATIO","code_information":[{"code":"Px00030012162","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LYME IGM BY WESTERN BLOT","code_information":[{"code":"Px00030012171","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LYME (B.BURGDORFERI) AB CSF","code_information":[{"code":"Px00030012172","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COX BURNETTI AB IGG PHASE 1&2","code_information":[{"code":"Px00030012173","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COXSACKIE B VIRUS ANTIBODIES","code_information":[{"code":"Px00030012179","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CULTURE AEROBIC IDENTIFY -AEROBIC ID W/MODIF","code_information":[{"code":"Px00030012193","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OVA AND PARASITED SMEARS W/MODIF","code_information":[{"code":"Px00030012197","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BORRELIA","code_information":[{"code":"Px00030012199","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TECH INTERP-1-SPT","code_information":[{"code":"Px00030012202","type":"CDM"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC QUICK STAIN ADDITIONAL TECH","code_information":[{"code":"Px00030012203","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTOPLASMIC KAPPA-FLOW","code_information":[{"code":"Px00030012204","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTOPLASMIC LAMBDA-FLOW","code_information":[{"code":"Px00030012205","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID 91","code_information":[{"code":"Px00030012206","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T ADP AGGREGATION WBPAGG TECH","code_information":[{"code":"Px00030012208","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CAMPYLOBACTER CULTR","code_information":[{"code":"Px00030012225","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTI-NEURONAL AB  IFA","code_information":[{"code":"Px00030012251","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTINOMYCES ANTIBODY","code_information":[{"code":"Px00030012386","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOLDX- CEBPA SEQUENCING","code_information":[{"code":"Px00030012402","type":"CDM"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.0,"discounted_cash":774.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC URINE PREGNANCY TEST","code_information":[{"code":"Px00030013001","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":27.0,"discounted_cash":18.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE","code_information":[{"code":"Px00030013003","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":15.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CERULOPLASMIN CDM","code_information":[{"code":"Px00030013004","type":"CDM"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEHYDROEPIANDROSTERONE","code_information":[{"code":"Px00030013005","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":177.0,"discounted_cash":123.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF MYOGLOBIN","code_information":[{"code":"Px00030013007","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":18.0,"discounted_cash":12.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030013010","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":235.0,"discounted_cash":164.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030013012","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF C-PEPTIDE","code_information":[{"code":"Px00030013013","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":164.0,"discounted_cash":114.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CRYOGLOBULIN","code_information":[{"code":"Px00030013016","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URINALYSIS VOLUME MEASURE","code_information":[{"code":"Px00030013017","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":22.0,"discounted_cash":15.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ADRENOCORTICOTROPIC HORMONE ACTH CDM","code_information":[{"code":"Px00030013018","type":"CDM"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":290.0,"discounted_cash":203.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ALDOLASE CDM","code_information":[{"code":"Px00030013019","type":"CDM"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":80.0,"discounted_cash":56.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN","code_information":[{"code":"Px00030013021","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THIAMINE VITAMIN B 1","code_information":[{"code":"Px00030013022","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":169.0,"discounted_cash":118.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T3 REVERSE","code_information":[{"code":"Px00030013024","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030013028","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALBUMIN CSF","code_information":[{"code":"Px00030013030","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COAGULATION TIME","code_information":[{"code":"Px00030013032","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030013034","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ANDROSTENEDIONE","code_information":[{"code":"Px00030013035","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":233.0,"discounted_cash":163.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 17 HYDROXYPREGNENOLONE","code_information":[{"code":"Px00030013037","type":"CDM"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY CARBOXYHB QUANT CDM","code_information":[{"code":"Px00030013039","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GENERAL HEALTH PANEL","code_information":[{"code":"Px00030013040","type":"CDM"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030013041","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CRYOFIBRINOGEN","code_information":[{"code":"Px00030013042","type":"CDM"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"Px00030013048","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SELENIUM CDM","code_information":[{"code":"Px00030013049","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOLINESTERASE ASSAY","code_information":[{"code":"Px00030013050","type":"CDM"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG ZONISAMIDE","code_information":[{"code":"Px00030013055","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XYLOSE TOLERANCE TEST","code_information":[{"code":"Px00030013056","type":"CDM"},{"code":"84620","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ZINC","code_information":[{"code":"Px00030013057","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR VIII TEST VWF","code_information":[{"code":"Px00030013059","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY LIPOPROTEIN PLA2","code_information":[{"code":"Px00030013061","type":"CDM"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED CHEMISTRY PROCEDURE CDM","code_information":[{"code":"Px00030013064","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":3795.0,"discounted_cash":2656.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH CDM","code_information":[{"code":"Px00030013075","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CROSS-LINKED N-TELOPEPTIDES","code_information":[{"code":"Px00030013078","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":148.0,"discounted_cash":103.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPOPRO BLD ELECTROPHORETIC","code_information":[{"code":"Px00030013079","type":"CDM"},{"code":"83700","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPOPROTEIN BLD BY NMR","code_information":[{"code":"Px00030013080","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":119.0,"discounted_cash":83.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF BREATH ETHANOL","code_information":[{"code":"Px00030013084","type":"CDM"},{"code":"82075","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROCALCITONIN (PCT) CDM","code_information":[{"code":"Px00030013086","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":212.0,"discounted_cash":148.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL OTHER SOURCE","code_information":[{"code":"Px00030013090","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN STABILITY SCREEN","code_information":[{"code":"Px00030013100","type":"CDM"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGF BINDING PROTEIN 3","code_information":[{"code":"Px00030013124","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYELIN BASIC PROTEIN CEREBROSPINAL FLUID CDM","code_information":[{"code":"Px00030013127","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG MYCOPHENOLIC","code_information":[{"code":"Px00030013132","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":506.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030013134","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF TROPONIN QUALITATIVE CDM","code_information":[{"code":"Px00030013136","type":"CDM"},{"code":"84512","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":63.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHENYLALANINE PKU BLOOD","code_information":[{"code":"Px00030013137","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":45.0,"discounted_cash":31.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030013138","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMINOLEVULINIC ACID UR (ARUP)","code_information":[{"code":"Px00030013151","type":"CDM"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESTRONE TMS(ARUP)","code_information":[{"code":"Px00030013181","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLIADIN AB IGG","code_information":[{"code":"Px00030013189","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GROWTH HORMONE (ARUP)","code_information":[{"code":"Px00030013192","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE AB IGG","code_information":[{"code":"Px00030013230","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC Z82542 (REF LAB)","code_information":[{"code":"Px00030013335","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ZCARNITINE (OF PANL)","code_information":[{"code":"Px00030013629","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ZINC PROTO (ZPP) BLOOD","code_information":[{"code":"Px00030013693","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF MANGANESE CDM","code_information":[{"code":"Px00030013773","type":"CDM"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF CALPROTECTIN FECAL CDM","code_information":[{"code":"Px00030013774","type":"CDM"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":302.0,"discounted_cash":211.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF INSULIN FREE CDM","code_information":[{"code":"Px00030013780","type":"CDM"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":509.0,"discounted_cash":356.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ARTERIAL BLOOD GASES","code_information":[{"code":"Px00030013788","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HYDROXYPROGESTERONE 17-D","code_information":[{"code":"Px00030013801","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":217.0,"discounted_cash":151.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPARIN ASSAY CDM","code_information":[{"code":"Px00030013803","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYELOPEROXIDASE ANTIBODY","code_information":[{"code":"Px00030013804","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HYDROXYPROGESTERONE 17-D CDM","code_information":[{"code":"Px00030013811","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":217.0,"discounted_cash":151.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOLINE BINDING ANTIBODY","code_information":[{"code":"Px00030013819","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00030013840","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM SERUM","code_information":[{"code":"Px00030013847","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE FLUID","code_information":[{"code":"Px00030013849","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV ADAMTS13 EA ANAL CDM","code_information":[{"code":"Px00030013855","type":"CDM"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESTRIOL UNCONJUGATED","code_information":[{"code":"Px00030013875","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":192.0,"discounted_cash":134.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030013878","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FATTY ACID PROFILE PEROXISOMAL","code_information":[{"code":"Px00030013879","type":"CDM"},{"code":"82726","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FECAL OSMOLALITY","code_information":[{"code":"Px00030013880","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030013881","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030013889","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL CDM","code_information":[{"code":"Px00030013890","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE CDM","code_information":[{"code":"Px00030013912","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00030013920","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYELIN BASIC PROTEIN CSF","code_information":[{"code":"Px00030013923","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PANCREATIC ELASTASE FECAL","code_information":[{"code":"Px00030013940","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PORPHOBILINOGEN DEAMINASE RBC","code_information":[{"code":"Px00030013946","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME 85610","code_information":[{"code":"Px00030013952","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTIME","code_information":[{"code":"Px00030013953","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS CDM","code_information":[{"code":"Px00030013969","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SODIUM","code_information":[{"code":"Px00030013978","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR CDM","code_information":[{"code":"Px00030013979","type":"CDM"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":290.0,"discounted_cash":203.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UROBILINOGEN URINE-QUAL","code_information":[{"code":"Px00030013992","type":"CDM"},{"code":"84578","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 17 HYDROXY-PREGNENOLONE","code_information":[{"code":"Px00030014004","type":"CDM"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRVVT","code_information":[{"code":"Px00030014048","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014052","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030014053","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00030014072","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOL MODULATING AB ASSAY","code_information":[{"code":"Px00030014075","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACETYLCHOLINE RECEPTOR ABY","code_information":[{"code":"Px00030014078","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACH GANGLIONIC NEURONAL AB","code_information":[{"code":"Px00030014085","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACH RECEPTOR (MUSC) BINDING AB","code_information":[{"code":"Px00030014087","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACHR GANGLIONIC NEURONAL ANTIB","code_information":[{"code":"Px00030014093","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":244.0,"discounted_cash":170.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ADAMTS 13 INHIBITOR","code_information":[{"code":"Px00030014104","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECTROPHOTOMETRY ADENOSINE DEAMINASE CDM","code_information":[{"code":"Px00030014105","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014112","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014113","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALDOSTERONE","code_information":[{"code":"Px00030014128","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":321.0,"discounted_cash":224.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALDOSTERONE BLD","code_information":[{"code":"Px00030014129","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":321.0,"discounted_cash":224.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALKALINE PHOS","code_information":[{"code":"Px00030014138","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00030014147","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALPHA-1 ANTITRYPSIN FECES","code_information":[{"code":"Px00030014150","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014151","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ALUMINUM CDM","code_information":[{"code":"Px00030014159","type":"CDM"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":337.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AMINO ACIDS PLASMA QUANT","code_information":[{"code":"Px00030014174","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":555.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":47.0,"discounted_cash":32.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMINO ACIDS URINE QUANT","code_information":[{"code":"Px00030014175","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":555.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":47.0,"discounted_cash":32.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMNIO ACIDS EA SPECIMEN","code_information":[{"code":"Px00030014180","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AMYLASE URINE","code_information":[{"code":"Px00030014228","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":303.0,"discounted_cash":212.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030014234","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME CDM","code_information":[{"code":"Px00030014236","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANGIOTENSIN CONVERT ENZYME CSF","code_information":[{"code":"Px00030014237","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTI GLIADIN AB IGA & IGG","code_information":[{"code":"Px00030014241","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN F FETAL QUALITATIVE LAB","code_information":[{"code":"Px00030014286","type":"CDM"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ARSENIC QUANT URINE","code_information":[{"code":"Px00030014291","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE SALIVARY","code_information":[{"code":"Px00030014323","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG ASSAY CYCLOSPORINE CDM","code_information":[{"code":"Px00030014330","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":95.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY TRANSFERRIN","code_information":[{"code":"Px00030014358","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ATP BY CHEMILUMINESCENCE","code_information":[{"code":"Px00030014361","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA-2 MICROGLOBULIN CDM","code_information":[{"code":"Px00030014367","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA 2 - MICROGLOBULIN","code_information":[{"code":"Px00030014401","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM","code_information":[{"code":"Px00030014403","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILE ACIDS TOTAL CDM","code_information":[{"code":"Px00030014414","type":"CDM"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL CDM","code_information":[{"code":"Px00030014418","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030014447","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT LEUKOCYTE WBC AUTOMATED CDM","code_information":[{"code":"Px00030014448","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":17.0,"discounted_cash":11.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD GASES SURGERYVENOUS","code_information":[{"code":"Px00030014450","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":194.0,"discounted_cash":135.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD GASES SURGERY ARTERIAL","code_information":[{"code":"Px00030014451","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":194.0,"discounted_cash":135.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BUN","code_information":[{"code":"Px00030014459","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF C-PEPTIDE CDM","code_information":[{"code":"Px00030014462","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":164.0,"discounted_cash":114.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CALCITONIN CDM","code_information":[{"code":"Px00030014480","type":"CDM"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":212.0,"discounted_cash":148.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014481","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014482","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030014484","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM. IONIZED SURGERY","code_information":[{"code":"Px00030014487","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARBON DIOXIDE BICARBONATE CDM","code_information":[{"code":"Px00030014495","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARNITINE FREE AND TOTAL","code_information":[{"code":"Px00030014497","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":47.0,"discounted_cash":32.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CAROTENE CDM","code_information":[{"code":"Px00030014498","type":"CDM"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CATECHOLAMINES FRACTIONATED CDM","code_information":[{"code":"Px00030014500","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CATECHOLAMINES URINE RANDOM","code_information":[{"code":"Px00030014505","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CBC WITH DIFF AUTO","code_information":[{"code":"Px00030014514","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030014520","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CENTROMERE B ANTIBODY","code_information":[{"code":"Px00030014526","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CERULOPLASMIN CDM","code_information":[{"code":"Px00030014527","type":"CDM"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"Px00030014542","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE URINE","code_information":[{"code":"Px00030014544","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHOLINESTERASE SERUM","code_information":[{"code":"Px00030014553","type":"CDM"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":63.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030014557","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030014558","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHROMIUM WHOLE BLOOD","code_information":[{"code":"Px00030014561","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF CITRATE CDM","code_information":[{"code":"Px00030014564","type":"CDM"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":218.0,"discounted_cash":152.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CK TOTAL","code_information":[{"code":"Px00030014566","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CK-MB","code_information":[{"code":"Px00030014567","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLLAGEN ADRENALIN PFSCN","code_information":[{"code":"Px00030014584","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLLAGEN EPINEPHERINE PFSCN","code_information":[{"code":"Px00030014588","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLUMN CHROMOTOGRAPHY QUANT","code_information":[{"code":"Px00030014590","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COPPER QUANT URINE","code_information":[{"code":"Px00030014600","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":88.0,"discounted_cash":61.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF COPPER CDM","code_information":[{"code":"Px00030014603","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":88.0,"discounted_cash":61.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030014605","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL FREE CDM","code_information":[{"code":"Px00030014606","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL - TOTAL","code_information":[{"code":"Px00030014607","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL FREE BY MAS SPECTROM","code_information":[{"code":"Px00030014615","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE CLEARANCE-SERUM + URINE","code_information":[{"code":"Px00030014631","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE URINE (REF)","code_information":[{"code":"Px00030014636","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYOFIBRINOGEN PLASMA","code_information":[{"code":"Px00030014641","type":"CDM"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYOGLOBULIN SERUM","code_information":[{"code":"Px00030014642","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-TELOPEPTIDE","code_information":[{"code":"Px00030014646","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYCLOSPORINE HEART TRANSPLANT","code_information":[{"code":"Px00030014651","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":95.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYSTATIN C CDM","code_information":[{"code":"Px00030014653","type":"CDM"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYSTINE URINE QUANT","code_information":[{"code":"Px00030014658","type":"CDM"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DDIMER QUANT","code_information":[{"code":"Px00030014674","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEHYDROEPIANDROSTERONE CDM","code_information":[{"code":"Px00030014683","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":202.0,"discounted_cash":141.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE CDM","code_information":[{"code":"Px00030014684","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":177.0,"discounted_cash":123.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE CDM","code_information":[{"code":"Px00030014685","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":177.0,"discounted_cash":123.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA QUANTITY ONLY","code_information":[{"code":"Px00030014700","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG URINE BY MS/MS","code_information":[{"code":"Px00030014761","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EARLYSCRN - PAPP-A","code_information":[{"code":"Px00030014771","type":"CDM"},{"code":"84163","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030014775","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00030014776","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN CDM","code_information":[{"code":"Px00030014795","type":"CDM"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESTRADIOL","code_information":[{"code":"Px00030014796","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":222.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TOTAL ESTRADIOL CDM","code_information":[{"code":"Px00030014798","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":222.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESTRADIOL BY LC MS MS","code_information":[{"code":"Px00030014799","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":222.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR 8","code_information":[{"code":"Px00030014823","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE CDM","code_information":[{"code":"Px00030014825","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR ANTIGEN CDM","code_information":[{"code":"Px00030014830","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR 9 INHIBITOR QUANT","code_information":[{"code":"Px00030014831","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR II PROTHROMBIN SPECIFIC CDM","code_information":[{"code":"Px00030014832","type":"CDM"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR IX PTC/CHRISTMAS CDM","code_information":[{"code":"Px00030014833","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR CDM","code_information":[{"code":"Px00030014834","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR CDM","code_information":[{"code":"Px00030014848","type":"CDM"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR X STUART-PROWER CDM","code_information":[{"code":"Px00030014866","type":"CDM"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR XI PTA CDM","code_information":[{"code":"Px00030014867","type":"CDM"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR XII HAGEMAN CDM","code_information":[{"code":"Px00030014868","type":"CDM"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":127.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB CDM","code_information":[{"code":"Px00030014869","type":"CDM"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":58.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FAT/LIPIDS FECES QUANTITATIVE CDM","code_information":[{"code":"Px00030014876","type":"CDM"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN CDM","code_information":[{"code":"Px00030014881","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":664.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":509.0,"discounted_cash":356.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS CDM","code_information":[{"code":"Px00030014892","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF FOLIC ACID SERUM CDM","code_information":[{"code":"Px00030014898","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF FOLIC ACID RBC CDM","code_information":[{"code":"Px00030014899","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FONDAPARINUX LEVEL","code_information":[{"code":"Px00030014900","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FREE T3 & TOTAL T3","code_information":[{"code":"Px00030014931","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM","code_information":[{"code":"Px00030014932","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00030014933","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GLYCATED PROTEIN CDM","code_information":[{"code":"Px00030014936","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014937","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014938","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE CDM","code_information":[{"code":"Px00030014945","type":"CDM"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GAMMA GT TOTAL","code_information":[{"code":"Px00030014949","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":60.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030014950","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GASTRIN CDM","code_information":[{"code":"Px00030014962","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":140.0,"discounted_cash":98.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE A","code_information":[{"code":"Px00030014979","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE","code_information":[{"code":"Px00030014980","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD","code_information":[{"code":"Px00030014981","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE FLUID","code_information":[{"code":"Px00030014983","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE QUALITATIVE URINE","code_information":[{"code":"Px00030014985","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)","code_information":[{"code":"Px00030014986","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE SERUM","code_information":[{"code":"Px00030014987","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLUCOSE SERUM EA ADDL/DAY","code_information":[{"code":"Px00030014988","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS","code_information":[{"code":"Px00030014990","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE SURGERY","code_information":[{"code":"Px00030015004","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE AN","code_information":[{"code":"Px00030015013","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C CDM","code_information":[{"code":"Px00030015020","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":80.0,"discounted_cash":56.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00030015029","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HPYLORI DRUG ADMINISTRATION CDM","code_information":[{"code":"Px00030015033","type":"CDM"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015036","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE CDM","code_information":[{"code":"Px00030015043","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HCG TOTAL QUANTITATIVE","code_information":[{"code":"Px00030015047","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HCG PRENATAL RISK","code_information":[{"code":"Px00030015048","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL CDM","code_information":[{"code":"Px00030015059","type":"CDM"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":640.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":530.0,"discounted_cash":371.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMATOCRIT (HCT)","code_information":[{"code":"Px00030015067","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMATOCRIT SPUN-MISC FLUID","code_information":[{"code":"Px00030015068","type":"CDM"},{"code":"85013","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015078","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOGLOBIN (HGB)","code_information":[{"code":"Px00030015080","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030015085","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN CDM","code_information":[{"code":"Px00030015086","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPARIN ASSAY CDM","code_information":[{"code":"Px00030015096","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HGB ELECTROPHORESIS FRACTION A2","code_information":[{"code":"Px00030015148","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HGB F QUANTITATIVE","code_information":[{"code":"Px00030015149","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN PLASMA CDM","code_information":[{"code":"Px00030015152","type":"CDM"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HOMOVANILLIC ACID (HVA)","code_information":[{"code":"Px00030015183","type":"CDM"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HVY MET BLD - ARSENIC","code_information":[{"code":"Px00030015188","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HVY MET BLD - LEAD","code_information":[{"code":"Px00030015190","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HVY MET BLD - MERCURY","code_information":[{"code":"Px00030015191","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HVY MET UR - ARSENIC","code_information":[{"code":"Px00030015192","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HVY MET UR - LEAD","code_information":[{"code":"Px00030015194","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HVY MET UR - MERCURY","code_information":[{"code":"Px00030015195","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SERUM-PROTEIN ELP SERUM","code_information":[{"code":"Px00030015206","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015207","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGA - GAMMAGLOBULIN","code_information":[{"code":"Px00030015210","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGE SERUM TOTAL","code_information":[{"code":"Px00030015213","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SOMATOMEDIN CDM","code_information":[{"code":"Px00030015214","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":169.0,"discounted_cash":118.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT IGF BP3 CDM","code_information":[{"code":"Px00030015217","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SOMATOMEDIN CDM","code_information":[{"code":"Px00030015218","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":146.0,"discounted_cash":102.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGG - GAMMAGLOBULIN","code_information":[{"code":"Px00030015219","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGG SUBCLASS 1","code_information":[{"code":"Px00030015225","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGG SUBCLASS 4","code_information":[{"code":"Px00030015228","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015229","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGG CSF","code_information":[{"code":"Px00030015230","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGM - GAMMAGLOBULIN","code_information":[{"code":"Px00030015231","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY NONINFECT AG QUANT","code_information":[{"code":"Px00030015245","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015258","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOGLOBULINS EACH","code_information":[{"code":"Px00030015260","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSULIN LEVEL ASSAY","code_information":[{"code":"Px00030015267","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IRON","code_information":[{"code":"Px00030015298","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IRON BINDING CAPACITY CDM","code_information":[{"code":"Px00030015300","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KAPPA QT FR LT CHAINS","code_information":[{"code":"Px00030015342","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KAPPA/LAMBDA LIGHT CHAIN RATIO","code_information":[{"code":"Px00030015344","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KETONE URINE QUALITATIVE","code_information":[{"code":"Px00030015349","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS CDM","code_information":[{"code":"Px00030015351","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":17.0,"discounted_cash":11.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LACTASE","code_information":[{"code":"Px00030015356","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030015357","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LACTOFERRIN FECAL QUALITATIVE","code_information":[{"code":"Px00030015358","type":"CDM"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":158.0,"discounted_cash":110.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LAMBDA FREE LIGHT CHAIN","code_information":[{"code":"Px00030015362","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LAMBDA QT FR LT CHAINS","code_information":[{"code":"Px00030015364","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC WBC ALKALINE PHOSPHATASE COUNT CDM","code_information":[{"code":"Px00030015366","type":"CDM"},{"code":"85540","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN CDM","code_information":[{"code":"Px00030015370","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CDM","code_information":[{"code":"Px00030015371","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LDH SERUM","code_information":[{"code":"Px00030015373","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL CDM","code_information":[{"code":"Px00030015375","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEAD BLOOD","code_information":[{"code":"Px00030015376","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEAD RANDOM URINE","code_information":[{"code":"Px00030015377","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEFLUNOMIDE AS METABOLITE","code_information":[{"code":"Px00030015383","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015391","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015392","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LIDOCAINE CDM","code_information":[{"code":"Px00030015393","type":"CDM"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIOW CYCLOSPORINE","code_information":[{"code":"Px00030015394","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":95.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPOPROTEIN (A) CDM","code_information":[{"code":"Px00030015399","type":"CDM"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LUP ANTICOAG-DRVVT","code_information":[{"code":"Px00030015407","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":63.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SODIUM OTHER SOURCE CDM","code_information":[{"code":"Px00030015417","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MAGNESIUM QUANT URINE","code_information":[{"code":"Px00030015421","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MAGNESIUM RBC","code_information":[{"code":"Px00030015422","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MALTASE","code_information":[{"code":"Px00030015426","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015448","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC METANEPHRINES URINE FRACT","code_information":[{"code":"Px00030015450","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":137.0,"discounted_cash":95.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ORGANIC ACID 1 QUANTITATIVE CDM","code_information":[{"code":"Px00030015460","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030015466","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: WSH 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":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MUCOPOLYSACCHARIDES ACID QUANT","code_information":[{"code":"Px00030015521","type":"CDM"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":159.0,"discounted_cash":111.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYOGLOBIN CDM","code_information":[{"code":"Px00030015558","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NI METABOLIC SCREEN CDM","code_information":[{"code":"Px00030015575","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC N-TYPE CALCIUM CHANNEL AB","code_information":[{"code":"Px00030015590","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":189.0,"discounted_cash":132.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OSMOLALITY STOOL CLINICAL CHEM TEST","code_information":[{"code":"Px00030015630","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OXALATE QUANT URINE","code_information":[{"code":"Px00030015633","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC P/Q TYPE CALCIUM CHANNEL ANTIB","code_information":[{"code":"Px00030015640","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC P/Q-TYPE CALCIUM CHANNEL AB","code_information":[{"code":"Px00030015641","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PALATINASE","code_information":[{"code":"Px00030015642","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PHENCYCLIDINE CDM","code_information":[{"code":"Px00030015662","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PH GASTRIC CDM","code_information":[{"code":"Px00030015674","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":27.0,"discounted_cash":18.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOSPHORUS QUANT URINE","code_information":[{"code":"Px00030015691","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS CDM","code_information":[{"code":"Px00030015693","type":"CDM"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":43.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION EACH AGENT","code_information":[{"code":"Px00030015695","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLUC BLD GLUC MNTR DEV","code_information":[{"code":"Px00030015715","type":"CDM"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030015716","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE BLOOD","code_information":[{"code":"Px00030015717","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030015718","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE CDM","code_information":[{"code":"Px00030015719","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM - SURGERY","code_information":[{"code":"Px00030015731","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM SERUM PLASMA/WHOLE BLOOD","code_information":[{"code":"Px00030015732","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM URINE QUANTITATIVE","code_information":[{"code":"Px00030015739","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015761","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030015763","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015764","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN WESTERN BLOT WITH INTERPRETATION AND REPORT BLOOD","code_information":[{"code":"Px00030015765","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":137.0,"discounted_cash":95.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORESIS BODY FLUID","code_information":[{"code":"Px00030015773","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN S AG TOTAL","code_information":[{"code":"Px00030015778","type":"CDM"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":76.0,"discounted_cash":53.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL URINE PAMC","code_information":[{"code":"Px00030015783","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN URINE QUANTITATIVE","code_information":[{"code":"Px00030015784","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN URINE RANDOM","code_information":[{"code":"Px00030015788","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00030015789","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEINASE-3 AB","code_information":[{"code":"Px00030015790","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEINASE-3 ANTIBODY EIA","code_information":[{"code":"Px00030015793","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PSA FREE","code_information":[{"code":"Px00030015809","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015810","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00030015823","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF PYRUVATE CDM","code_information":[{"code":"Px00030015836","type":"CDM"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":88.0,"discounted_cash":61.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG NORFLUOXETINE","code_information":[{"code":"Px00030015849","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC OSMOTIC FRA","code_information":[{"code":"Px00030015864","type":"CDM"},{"code":"85557","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":88.0,"discounted_cash":61.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":47.0,"discounted_cash":32.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF RENIN CDM","code_information":[{"code":"Px00030015879","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":175.0,"discounted_cash":122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT RETICULOCYTE AUTOMATED CDM","code_information":[{"code":"Px00030015882","type":"CDM"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT RETICULOCYTE MANUAL CDM","code_information":[{"code":"Px00030015884","type":"CDM"},{"code":"85044","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SELENIUM SERUM","code_information":[{"code":"Px00030015900","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SEROTONIN","code_information":[{"code":"Px00030015924","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":209.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":246.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SEX HORMONE BINDING GLOBU","code_information":[{"code":"Px00030015927","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"Px00030015928","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":173.0,"discounted_cash":121.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SGPT (ALT)","code_information":[{"code":"Px00030015931","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":45.0,"discounted_cash":31.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM BODY FLUID","code_information":[{"code":"Px00030015946","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM SURGERY","code_information":[{"code":"Px00030015950","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM URINE QUANTITATIVE","code_information":[{"code":"Px00030015952","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SOLUABLE TRANSFERRIN RECEPTOR","code_information":[{"code":"Px00030015955","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030015957","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE CDM","code_information":[{"code":"Px00030015963","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":15.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PH STOOL CDM","code_information":[{"code":"Px00030015971","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":27.0,"discounted_cash":18.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUCRASE","code_information":[{"code":"Px00030015976","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE OTHER SOURCE CDM","code_information":[{"code":"Px00030015995","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM","code_information":[{"code":"Px00030015997","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRIIODOTHYRONINE T3 REVERSE CDM","code_information":[{"code":"Px00030015998","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":127.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"Px00030016000","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS CDM","code_information":[{"code":"Px00030016004","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TEG 3","code_information":[{"code":"Px00030016005","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":53.0,"discounted_cash":37.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TEG 4","code_information":[{"code":"Px00030016006","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL CDM","code_information":[{"code":"Px00030016009","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":209.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":204.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TESTOSTERONE FREE","code_information":[{"code":"Px00030016011","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":158.0,"discounted_cash":110.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030016021","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THIOCYANATE.","code_information":[{"code":"Px00030016025","type":"CDM"},{"code":"84430","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":356.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBIN III ACTIVITY","code_information":[{"code":"Px00030016030","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY LAB","code_information":[{"code":"Px00030016031","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":71.0,"discounted_cash":49.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOXANE METABOLITE URINE","code_information":[{"code":"Px00030016036","type":"CDM"},{"code":"84431","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN LEVEL","code_information":[{"code":"Px00030016037","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":83.0,"discounted_cash":58.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROID STIMULATING IMMUNE GLOBULINS TSI CDM","code_information":[{"code":"Px00030016040","type":"CDM"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":401.0,"discounted_cash":280.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROID STIMULATING HORMONE (TSH)","code_information":[{"code":"Px00030016041","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROXINE T4","code_information":[{"code":"Px00030016044","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRIGLYCERIDE","code_information":[{"code":"Px00030016084","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030016086","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030016091","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":81.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE TRYPTASE CDM","code_information":[{"code":"Px00030016097","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UREA QUANT URINE","code_information":[{"code":"Px00030016112","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UREA DIALYSATE","code_information":[{"code":"Px00030016113","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UREA URINE RANDOM","code_information":[{"code":"Px00030016115","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE LAB","code_information":[{"code":"Px00030016119","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION CDM","code_information":[{"code":"Px00030016152","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC USC THYROGLUBLIN LEVEL","code_information":[{"code":"Px00030016153","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":83.0,"discounted_cash":58.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VANILLYLMANDELIC ACID URN ARUP","code_information":[{"code":"Px00030016165","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THIAMINE-VITAMIN B-1 CDM","code_information":[{"code":"Px00030016184","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":169.0,"discounted_cash":118.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PYRIDOXAL PHOSPHATE CDM","code_information":[{"code":"Px00030016188","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030016189","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":306.0,"discounted_cash":214.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VITAMIN-B12","code_information":[{"code":"Px00030016196","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VANILLYLMANDELIC ACID URINE CDM","code_information":[{"code":"Px00030016198","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VMA URINE RANDOM","code_information":[{"code":"Px00030016200","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VOLTAGE GATED CA CHANNEL AB","code_information":[{"code":"Px00030016203","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS CDM","code_information":[{"code":"Px00030016210","type":"CDM"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT CDM","code_information":[{"code":"Px00030016213","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR ANTIGEN","code_information":[{"code":"Px00030016214","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00030016220","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00030016230","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC STAPH AUREUS METHICILLIN RESISTANT AMPLIFIED PROBE","code_information":[{"code":"Px00030016253","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE","code_information":[{"code":"Px00030016255","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VW PROFILE-FACTOR ACTIVITY","code_information":[{"code":"Px00030016261","type":"CDM"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":65.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD PH ONLY CDM","code_information":[{"code":"Px00030016274","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE URINE","code_information":[{"code":"Px00030016275","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016280","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS CDM","code_information":[{"code":"Px00030016284","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KAPPA QUANT FREE LT CHAIN","code_information":[{"code":"Px00030016304","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONNEXIN 26 (GJB2) ANALYSIS","code_information":[{"code":"Px00030016318","type":"CDM"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LYSOZYME","code_information":[{"code":"Px00030016329","type":"CDM"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CITRATE ELP","code_information":[{"code":"Px00030016335","type":"CDM"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030016339","type":"CDM"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GC (AMP DNA PROBE)","code_information":[{"code":"Px00030017027","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPID PROFILE","code_information":[{"code":"Px00030017031","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030017035","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE CDM","code_information":[{"code":"Px00030017049","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":984.0,"discounted_cash":688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLUCOSE WHOLE BLOOD","code_information":[{"code":"Px00030017053","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1524.0,"discounted_cash":1066.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":99.0,"discounted_cash":69.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG ASSAY ACETAMINOPHEN LAB","code_information":[{"code":"Px00030100039","type":"CDM"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY SALICYLATE LAB","code_information":[{"code":"Px00030100043","type":"CDM"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY LEFLUNOMIDE LAB","code_information":[{"code":"Px00030100046","type":"CDM"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY METHOTREXATE LAB","code_information":[{"code":"Px00030100047","type":"CDM"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100053","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VANILLYLMANDELIC ACID URINE LAB","code_information":[{"code":"Px00030100054","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":112.0,"discounted_cash":78.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100085","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HOMOVANILLIC ACID LAB","code_information":[{"code":"Px00030100086","type":"CDM"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG ASSAY METHOTREXATE LAB","code_information":[{"code":"Px00030100110","type":"CDM"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100117","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100121","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100123","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100124","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100126","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM","code_information":[{"code":"Px00030100127","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL","code_information":[{"code":"Px00030100128","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE","code_information":[{"code":"Px00030100129","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME LAB","code_information":[{"code":"Px00030100132","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100136","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":192.0,"discounted_cash":134.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100137","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100140","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":137.0,"discounted_cash":95.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13 OR MORE LAB","code_information":[{"code":"Px00030100158","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1160.0,"discounted_cash":812.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS CDM","code_information":[{"code":"Px00030100178","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100186","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100196","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE OTHER SOURCE LAB","code_information":[{"code":"Px00030100198","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100200","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE OTHER SOURCE LAB","code_information":[{"code":"Px00030100201","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEMAN LAB","code_information":[{"code":"Px00030100202","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","code_information":[{"code":"Px00030100203","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN UNSTABLE SCREEN LAB","code_information":[{"code":"Px00030100204","type":"CDM"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100208","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100215","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":695.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030100222","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100238","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030100239","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":176.0,"discounted_cash":123.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030100246","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030100260","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELASTASE PANCREATIC FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030100376","type":"CDM"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100377","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100382","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030100392","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100396","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100397","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100408","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100409","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100414","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100415","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF ALCOHOL (ETHANOL) SPEC XCP UR&BREATH IA LAB","code_information":[{"code":"Px00030100421","type":"CDM"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100454","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100455","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":81.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100483","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM SERUM PLASMA OR WHOLE BLOOD LAB","code_information":[{"code":"Px00030100484","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID LAB","code_information":[{"code":"Px00030100485","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY LAB","code_information":[{"code":"Px00030100487","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100489","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":112.0,"discounted_cash":78.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREENING OXYCODONE LAB","code_information":[{"code":"Px00030100513","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100524","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100541","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100542","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS LAB","code_information":[{"code":"Px00030100543","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE VANCOMYCIN LAB","code_information":[{"code":"Px00030100544","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":125.0,"discounted_cash":87.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100555","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100563","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100564","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100566","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100567","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030100568","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100569","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100570","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100571","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN DIRECT LAB","code_information":[{"code":"Px00030100572","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030100574","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100576","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030100577","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100579","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100580","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100581","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100582","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CREATINE KINASE TOTAL LAB","code_information":[{"code":"Px00030100585","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100587","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100588","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100592","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100593","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100594","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100595","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100596","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":222.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100609","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100610","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE LAB","code_information":[{"code":"Px00030100616","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE","code_information":[{"code":"Px00030100617","type":"CDM"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":530.0,"discounted_cash":371.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HPYLORI DRUG ADMINISTRATION","code_information":[{"code":"Px00030100618","type":"CDM"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL LAB","code_information":[{"code":"Px00030100622","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF INSULIN FREE LAB","code_information":[{"code":"Px00030100623","type":"CDM"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100624","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100625","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE LAB","code_information":[{"code":"Px00030100626","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES LAB","code_information":[{"code":"Px00030100627","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":119.0,"discounted_cash":83.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030100628","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100630","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100631","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030100632","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE LAB","code_information":[{"code":"Px00030100634","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030100635","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100636","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100637","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100638","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100639","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100640","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100644","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100645","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030100647","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE LAB","code_information":[{"code":"Px00030100649","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF PROINSULIN LAB","code_information":[{"code":"Px00030100650","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":142.0,"discounted_cash":99.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030100651","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":173.0,"discounted_cash":121.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100652","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030100653","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030100654","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":158.0,"discounted_cash":110.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100655","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":204.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100656","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":204.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100657","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":204.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100658","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030100659","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100661","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100662","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100663","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100664","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100665","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100666","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":81.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100667","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID LAB","code_information":[{"code":"Px00030100668","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100671","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100672","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG ASSAY INFLIXIMAB LAB","code_information":[{"code":"Px00030100760","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030100761","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100762","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CORTISOL TOTAL","code_information":[{"code":"Px00030100764","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD LAB","code_information":[{"code":"Px00030100765","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100766","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB","code_information":[{"code":"Px00030100770","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRIGLYCERIDES LAB","code_information":[{"code":"Px00030100771","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ZINC LAB","code_information":[{"code":"Px00030100772","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100775","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE LAB","code_information":[{"code":"Px00030100776","type":"CDM"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100777","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030100780","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":83.0,"discounted_cash":58.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100812","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030100818","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":617.0,"discounted_cash":431.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":511.0,"discounted_cash":357.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100855","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100856","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF PHENCYCLIDINE LAB","code_information":[{"code":"Px00030100861","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100862","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100958","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) LAB","code_information":[{"code":"Px00030100967","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":205.0,"discounted_cash":143.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030101031","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030101041","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030101044","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030101045","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101046","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":153.0,"discounted_cash":107.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101047","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":153.0,"discounted_cash":107.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF FOLIC ACID RBC LAB","code_information":[{"code":"Px00030101050","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":137.0,"discounted_cash":95.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101056","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101058","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101059","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101060","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101062","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101063","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030101066","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID","code_information":[{"code":"Px00030101069","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101072","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":266.0,"discounted_cash":186.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101073","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":266.0,"discounted_cash":186.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101085","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":85.0,"discounted_cash":59.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101086","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":85.0,"discounted_cash":59.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030101278","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":129.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN LAB","code_information":[{"code":"Px00030101279","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":129.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030101284","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030101322","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":31.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030101361","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":147.0,"discounted_cash":102.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030110064","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":147.0,"discounted_cash":102.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL LAB","code_information":[{"code":"Px00030110073","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":122.0,"discounted_cash":85.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID CDM","code_information":[{"code":"Px00030110077","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030110082","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030110084","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LIPID PANEL OF NMR","code_information":[{"code":"Px00030110101","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY","code_information":[{"code":"Px00030110102","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":194.0,"discounted_cash":135.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD GASES W/O2 SATURATION CDM","code_information":[{"code":"Px00030110103","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":194.0,"discounted_cash":135.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110104","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD GAS","code_information":[{"code":"Px00030110105","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110106","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110107","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY CLOMIPRAMINE METABOLITE","code_information":[{"code":"Px00030110122","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY CLOZAPINE NORCLOZAPINE","code_information":[{"code":"Px00030110123","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY ISONIAZID","code_information":[{"code":"Px00030110124","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DESMETHYDOXEPIN","code_information":[{"code":"Px00030110125","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CAFFEINE LAB","code_information":[{"code":"Px00030110127","type":"CDM"},{"code":"80155","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CLOZAPINE LAB","code_information":[{"code":"Px00030110128","type":"CDM"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT EVEROLIMUS LAB","code_information":[{"code":"Px00030110129","type":"CDM"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE GABAPENTIN LAB","code_information":[{"code":"Px00030110130","type":"CDM"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE LAB","code_information":[{"code":"Px00030110131","type":"CDM"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCRN QUAN LEVETIRACETAM","code_information":[{"code":"Px00030110132","type":"CDM"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE MYCOPHENOLATE LAB","code_information":[{"code":"Px00030110133","type":"CDM"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCRN QUANT OXCARBAZEPIN LAB","code_information":[{"code":"Px00030110134","type":"CDM"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ZONISAMIDE LAB","code_information":[{"code":"Px00030110136","type":"CDM"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES","code_information":[{"code":"Px00030110156","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":655.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030110165","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110166","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110167","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110168","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LACTOFERRIN FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030110181","type":"CDM"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":158.0,"discounted_cash":110.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL LAB","code_information":[{"code":"Px00030110185","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF PARATHORMONE LAB","code_information":[{"code":"Px00030110189","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110193","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110194","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030110211","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":583.0,"discounted_cash":408.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY ADALIMUMAB LAB","code_information":[{"code":"Px00030110238","type":"CDM"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB","code_information":[{"code":"Px00030110240","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY LACOSAMIDE LAB","code_information":[{"code":"Px00030110241","type":"CDM"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL LAB","code_information":[{"code":"Px00030110250","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE","code_information":[{"code":"Px00030110253","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":393.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CC MSC CYSTIC FIBROSIS COMMON MUTATION SCRN","code_information":[{"code":"Px00030110274","type":"CDM"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030110305","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030110444","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2","code_information":[{"code":"Px00030110459","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030110479","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110480","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL CDM","code_information":[{"code":"Px00030110510","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF OXALATE LAB","code_information":[{"code":"Px00030110532","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030110534","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE BLOOD REAGENT STRIP","code_information":[{"code":"Px00030110569","type":"CDM"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ALDOSTERONE PLASMA LAB","code_information":[{"code":"Px00030110584","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":321.0,"discounted_cash":224.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030110600","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":31.0,"discounted_cash":21.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"Px00030110602","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":125.0,"discounted_cash":87.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030110603","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":147.0,"discounted_cash":102.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110605","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":43.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROCAINAMIDE & NAPA","code_information":[{"code":"Px00030110623","type":"CDM"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS CDM","code_information":[{"code":"Px00030110635","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALKALOIDS NOS","code_information":[{"code":"Px00030110638","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":87.0,"discounted_cash":60.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMPHETAMINES 3OR 4","code_information":[{"code":"Px00030110640","type":"CDM"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AMPHETAMINES 5 OR MORE","code_information":[{"code":"Px00030110641","type":"CDM"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIDEPRESSANTS CLASS 1 OR 2","code_information":[{"code":"Px00030110647","type":"CDM"},{"code":"80332","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIDEPRESSANTS CLASS 3-5","code_information":[{"code":"Px00030110648","type":"CDM"},{"code":"80333","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030110653","type":"CDM"},{"code":"80338","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIEPILEPTICS NOS 1-3","code_information":[{"code":"Px00030110654","type":"CDM"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3","code_information":[{"code":"Px00030110657","type":"CDM"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOS 4-6","code_information":[{"code":"Px00030110658","type":"CDM"},{"code":"80343","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES CDM","code_information":[{"code":"Px00030110660","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":65.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BENZODIAZEPINES 13 OR MORE","code_information":[{"code":"Px00030110662","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE LAB","code_information":[{"code":"Px00030110663","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CANNABINOIDS NATURAL","code_information":[{"code":"Px00030110664","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE","code_information":[{"code":"Px00030110668","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":85.0,"discounted_cash":59.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREENING FENTANYL CDM","code_information":[{"code":"Px00030110669","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING HEROIN METABOLITE CDM","code_information":[{"code":"Px00030110671","type":"CDM"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING METHADONE CDM","code_information":[{"code":"Px00030110673","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030110674","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":80.0,"discounted_cash":56.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC METHYLPHENIDATE","code_information":[{"code":"Px00030110675","type":"CDM"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPIATES 1 OR MORE","code_information":[{"code":"Px00030110676","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPIOIDS & OPIATE ANALOGS 1 OR 2","code_information":[{"code":"Px00030110677","type":"CDM"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPIOID &OPIATE ANALOG 5/MORE","code_information":[{"code":"Px00030110679","type":"CDM"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE","code_information":[{"code":"Px00030110680","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING PROPOXYPHENE","code_information":[{"code":"Px00030110682","type":"CDM"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL LAB","code_information":[{"code":"Px00030110688","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE NOS 1-3","code_information":[{"code":"Px00030110690","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CORTISOL FREE LAB","code_information":[{"code":"Px00030110741","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030110747","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":153.0,"discounted_cash":107.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACYLCARNITINES QUANTIATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030110810","type":"CDM"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":237.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":133.0,"discounted_cash":93.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE BLOOD REAGENT STRIP LAB","code_information":[{"code":"Px00030112001","type":"CDM"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SERUM ALBUMIN","code_information":[{"code":"Px00030112003","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OCCULT BLOOD FECES","code_information":[{"code":"Px00030112004","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"Px00030112005","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATINE MB FRACTION","code_information":[{"code":"Px00030112006","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRANSFERRIN","code_information":[{"code":"Px00030112011","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SOMATOMEDIN LAB","code_information":[{"code":"Px00030112012","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":169.0,"discounted_cash":118.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANT","code_information":[{"code":"Px00030112013","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF MAGNESIUM","code_information":[{"code":"Px00030112014","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD CHLORIDE","code_information":[{"code":"Px00030112015","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM BLOOD","code_information":[{"code":"Px00030112016","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TACROLIMUS","code_information":[{"code":"Px00030112019","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROALBUMIN QUANTITATIVE","code_information":[{"code":"Px00030112020","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030112022","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030112023","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NATRIURETIC PEPTIDE","code_information":[{"code":"Px00030112024","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TEST FOR ACETONE/KETONES","code_information":[{"code":"Px00030112025","type":"CDM"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030112027","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS ACUTE PANEL","code_information":[{"code":"Px00030112029","type":"CDM"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":217.0,"discounted_cash":151.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHORIONIC GONADOTROPIN QUAL","code_information":[{"code":"Px00030112030","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"Px00030112031","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112032","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"Px00030112033","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF FETAL FIBRONECTIN","code_information":[{"code":"Px00030112034","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":664.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":509.0,"discounted_cash":356.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PH BODY FLUID NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030112035","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":27.0,"discounted_cash":18.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF URINE VMA","code_information":[{"code":"Px00030112036","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LEAD","code_information":[{"code":"Px00030112037","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VITAMIN A LAB","code_information":[{"code":"Px00030112039","type":"CDM"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF NUCLEOTIDASE 5 LAB","code_information":[{"code":"Px00030112041","type":"CDM"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"Px00030112043","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"Px00030112044","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":53.0,"discounted_cash":37.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PREALBUMIN CDM","code_information":[{"code":"Px00030112045","type":"CDM"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL CDM","code_information":[{"code":"Px00030112046","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE CDM","code_information":[{"code":"Px00030112048","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CALCITONIN","code_information":[{"code":"Px00030112049","type":"CDM"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":212.0,"discounted_cash":148.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL LAB","code_information":[{"code":"Px00030112050","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RENIN","code_information":[{"code":"Px00030112051","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":175.0,"discounted_cash":122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VOLATILES","code_information":[{"code":"Px00030112053","type":"CDM"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":129.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL FREE CDM","code_information":[{"code":"Px00030112054","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC POTASSIUM URINE","code_information":[{"code":"Px00030112055","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN LAB","code_information":[{"code":"Px00030112056","type":"CDM"},{"code":"82960","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":52.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OSMOLALITY BLOOD","code_information":[{"code":"Px00030112058","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030112060","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BASIC METABOLIC PANEL","code_information":[{"code":"Px00030112061","type":"CDM"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPREHEN METABOLIC PANEL","code_information":[{"code":"Px00030112062","type":"CDM"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"Px00030112063","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RENAL FUNCTION PANEL CDM","code_information":[{"code":"Px00030112064","type":"CDM"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROXINE FREE","code_information":[{"code":"Px00030112065","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00030112067","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":163.0,"discounted_cash":114.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GTT-ADDED SAMPLES","code_information":[{"code":"Px00030112068","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"Px00030112069","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":222.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE THEOPHYLLINE CDM","code_information":[{"code":"Px00030112071","type":"CDM"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOSPHORUS URINE","code_information":[{"code":"Px00030112072","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00030112073","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF FOLIC ACID RBC","code_information":[{"code":"Px00030112074","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF OXALATE CDM","code_information":[{"code":"Px00030112077","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG GABAPENTINE","code_information":[{"code":"Px00030112078","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VIT D 1 25-DIHYDROXY","code_information":[{"code":"Px00030112079","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":306.0,"discounted_cash":214.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY GROWTH HORMONE (HGH)","code_information":[{"code":"Px00030112080","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CYANIDE","code_information":[{"code":"Px00030112082","type":"CDM"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE LAB","code_information":[{"code":"Px00030112083","type":"CDM"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PYRIDOXAL PHOSPHATE VITAMIN B 6","code_information":[{"code":"Px00030112084","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE CDM","code_information":[{"code":"Px00030112088","type":"CDM"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SEROTONIN","code_information":[{"code":"Px00030112089","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":209.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":246.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LIPOPROTEIN(A) LAB","code_information":[{"code":"Px00030112090","type":"CDM"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE LAB","code_information":[{"code":"Px00030112091","type":"CDM"},{"code":"80192","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROGESTERONE","code_information":[{"code":"Px00030112092","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":217.0,"discounted_cash":151.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SIROLIMUS","code_information":[{"code":"Px00030112093","type":"CDM"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOPIRAMATE LAB","code_information":[{"code":"Px00030112094","type":"CDM"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE QUINIDINE CDM","code_information":[{"code":"Px00030112097","type":"CDM"},{"code":"80194","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE LAB","code_information":[{"code":"Px00030112098","type":"CDM"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00030112100","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY BLOOD CARBON DIOXIDE","code_information":[{"code":"Px00030112102","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATIC FUNCTION PANEL CDM","code_information":[{"code":"Px00030112103","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALANINE AMINO (ALT) (SGPT)","code_information":[{"code":"Px00030112104","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":45.0,"discounted_cash":31.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GGT","code_information":[{"code":"Px00030112105","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":60.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD FOLIC ACID SERUM","code_information":[{"code":"Px00030112106","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY PHOSPHORUS","code_information":[{"code":"Px00030112107","type":"CDM"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030112108","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL CDM","code_information":[{"code":"Px00030112109","type":"CDM"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":122.0,"discounted_cash":85.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN","code_information":[{"code":"Px00030112110","type":"CDM"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF FERRITIN","code_information":[{"code":"Px00030112111","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112112","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FREE ASSAY (FT-3)","code_information":[{"code":"Px00030112114","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030112115","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":204.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LITHIUM CDM","code_information":[{"code":"Px00030112116","type":"CDM"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":63.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IRON BINDING CAPACITY LAB","code_information":[{"code":"Px00030112117","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROXINE TOTAL","code_information":[{"code":"Px00030112118","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LDH ENZYMES","code_information":[{"code":"Px00030112122","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN","code_information":[{"code":"Px00030112123","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PRIMIDONE LAB","code_information":[{"code":"Px00030112124","type":"CDM"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID (T3 OR T4)","code_information":[{"code":"Px00030112125","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD PH ONLY","code_information":[{"code":"Px00030112126","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY 17- KETOSTEROIDS","code_information":[{"code":"Px00030112127","type":"CDM"},{"code":"83586","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GASTRIN","code_information":[{"code":"Px00030112128","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":140.0,"discounted_cash":98.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG LAMOTRIGINE","code_information":[{"code":"Px00030112130","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VASOACTIVE INTESTINAL PEPTIDE LAB","code_information":[{"code":"Px00030112134","type":"CDM"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":282.0,"discounted_cash":197.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HEMOSIDERIN QUALITATIVE LAB","code_information":[{"code":"Px00030112135","type":"CDM"},{"code":"83070","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCULUS SPECTROSCOPY","code_information":[{"code":"Px00030112138","type":"CDM"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOSPHATIDYLGLYCEROL","code_information":[{"code":"Px00030112140","type":"CDM"},{"code":"84081","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030112142","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":153.0,"discounted_cash":107.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROINSULIN","code_information":[{"code":"Px00030112143","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":142.0,"discounted_cash":99.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DHEA","code_information":[{"code":"Px00030112148","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":202.0,"discounted_cash":141.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG KEPPRA","code_information":[{"code":"Px00030112150","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACTH STIMULATION PANEL","code_information":[{"code":"Px00030112151","type":"CDM"},{"code":"80400","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":244.0,"discounted_cash":170.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN F FETAL QUALITATIVE LAB","code_information":[{"code":"Px00030112154","type":"CDM"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRYPTASE","code_information":[{"code":"Px00030112155","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TRIGLYCERIDES","code_information":[{"code":"Px00030112157","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030112158","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE","code_information":[{"code":"Px00030112159","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PARATHORMONE (PARATHYROID HORMONE)","code_information":[{"code":"Px00030112161","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT","code_information":[{"code":"Px00030112162","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"Px00030112164","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN FREE","code_information":[{"code":"Px00030112165","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VITAMIN B-12","code_information":[{"code":"Px00030112166","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CARNITINE","code_information":[{"code":"Px00030112171","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":47.0,"discounted_cash":32.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM URINE","code_information":[{"code":"Px00030112172","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYCLOSPORINE","code_information":[{"code":"Px00030112173","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":95.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL CDM","code_information":[{"code":"Px00030112174","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":125.0,"discounted_cash":87.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TOCOPHEROL ALPHA VITAMIN E LAB","code_information":[{"code":"Px00030112175","type":"CDM"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG CAFFEINE","code_information":[{"code":"Px00030112177","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OLIGOCLONAL IMMUNE","code_information":[{"code":"Px00030112178","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":112.0,"discounted_cash":78.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE ISOENZYME","code_information":[{"code":"Px00030112180","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":314.0,"discounted_cash":219.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILE ACIDS TOTAL","code_information":[{"code":"Px00030112183","type":"CDM"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF VITAMIN K LAB","code_information":[{"code":"Px00030112185","type":"CDM"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SODIUM OTHER SOURCE LAB","code_information":[{"code":"Px00030112190","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY TRIIODOTHYRONINE (T3)","code_information":[{"code":"Px00030112193","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112195","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG AMIODARONE","code_information":[{"code":"Px00030112196","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG FLECAINIDE","code_information":[{"code":"Px00030112197","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GLUCAGON LAB","code_information":[{"code":"Px00030112198","type":"CDM"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE CDM","code_information":[{"code":"Px00030112199","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY DIPROPYLACETIC ACID DEPAKANE","code_information":[{"code":"Px00030112201","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":125.0,"discounted_cash":87.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY RBC CHOLINESTERASE","code_information":[{"code":"Px00030112203","type":"CDM"},{"code":"82482","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":63.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG CLOZAPINE","code_information":[{"code":"Px00030112210","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ASCORBIC ACID","code_information":[{"code":"Px00030112213","type":"CDM"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG METHOTREXATE LAB","code_information":[{"code":"Px00030112215","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030112216","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY CREATININE","code_information":[{"code":"Px00030112217","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF BETA-2 PROTEIN","code_information":[{"code":"Px00030112218","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ESTROGENS TOTAL LAB","code_information":[{"code":"Px00030112220","type":"CDM"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PHOSPHATASE ALKALINE ISOENZYMES","code_information":[{"code":"Px00030112222","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG DIGITOXIN LAB","code_information":[{"code":"Px00030112223","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG FELBAMATE","code_information":[{"code":"Px00030112224","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RECEPTOR ASSAY NON ENDOCRINE","code_information":[{"code":"Px00030112226","type":"CDM"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":290.0,"discounted_cash":203.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL CDM","code_information":[{"code":"Px00030112228","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":122.0,"discounted_cash":85.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM","code_information":[{"code":"Px00030112229","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030112248","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHOLESTEROL","code_information":[{"code":"Px00030112251","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF CHROMIUM","code_information":[{"code":"Px00030112254","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF CSF PROTEIN","code_information":[{"code":"Px00030112256","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE CLEARANCE","code_information":[{"code":"Px00030112259","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UREA NITROGEN CLEARANCE LAB","code_information":[{"code":"Px00030112261","type":"CDM"},{"code":"84545","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":52.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN B-100","code_information":[{"code":"Px00030112264","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":81.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112268","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN E","code_information":[{"code":"Px00030112272","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PH BODY FLUID LAB","code_information":[{"code":"Px00030112273","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":27.0,"discounted_cash":18.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG FLUXETINE","code_information":[{"code":"Px00030112275","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN","code_information":[{"code":"Px00030112287","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LEAD CDM","code_information":[{"code":"Px00030112289","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RIA NONANTIBODY ACETYLCHOLINE BINDING AB","code_information":[{"code":"Px00030112297","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMYLASE","code_information":[{"code":"Px00030112298","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RIA NONANTIBODY IGF BINDING PROTEIN LAB","code_information":[{"code":"Px00030112302","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CDM","code_information":[{"code":"Px00030112303","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG AMIODARONE METABOLITE","code_information":[{"code":"Px00030112305","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACYLCARNITINES QUANT","code_information":[{"code":"Px00030112306","type":"CDM"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":47.0,"discounted_cash":32.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112310","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC METHYLMALONIC ACID QUANTITATIVE LAB","code_information":[{"code":"Px00030112311","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATIVE ASSAY DRUG MEXILETINE LAB","code_information":[{"code":"Px00030112313","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TOTAL PROTEIN","code_information":[{"code":"Px00030112314","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANDROSTENEDIONE LAB","code_information":[{"code":"Px00030112315","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":233.0,"discounted_cash":163.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030112324","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030112325","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLUCOSE","code_information":[{"code":"Px00030112329","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030112330","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TESTOSTERONE","code_information":[{"code":"Px00030112336","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":204.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ZINC PROTOPORPHYRINS","code_information":[{"code":"Px00030112337","type":"CDM"},{"code":"84203","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMNIOTIC FLUID SCAN","code_information":[{"code":"Px00030112339","type":"CDM"},{"code":"82143","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE FLUID","code_information":[{"code":"Px00030112342","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030112351","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CATECHOLAMINES FRACTIONATED URINE 24HR LAB","code_information":[{"code":"Px00030112353","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030112358","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE DIALYSATE","code_information":[{"code":"Px00030112359","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENZYME CELL ACTIVITY LAB","code_information":[{"code":"Px00030112361","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GROWTH HORMONE PANEL","code_information":[{"code":"Px00030112363","type":"CDM"},{"code":"80428","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":494.0,"discounted_cash":345.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN E (IGE)","code_information":[{"code":"Px00030112366","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LDH FLUID","code_information":[{"code":"Px00030112369","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYOGLOBIN SERUM","code_information":[{"code":"Px00030112373","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF OSMOLALITY BLOOD","code_information":[{"code":"Px00030112375","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PTH C-TERMINAL","code_information":[{"code":"Px00030112379","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":592.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":326.0,"discounted_cash":228.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030112380","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC SGOT (AST)","code_information":[{"code":"Px00030112384","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RIA NONANTIBODY ACETYLCHOLINE RECEPTOR","code_information":[{"code":"Px00030112390","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL URINE","code_information":[{"code":"Px00030112394","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMIKACIN","code_information":[{"code":"Px00030112403","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CEA","code_information":[{"code":"Px00030112404","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL CSF","code_information":[{"code":"Px00030112411","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHOLESTEROL BODY FLUID","code_information":[{"code":"Px00030112412","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED","code_information":[{"code":"Px00030112425","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030112474","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MERCURY QUANTITATIVE","code_information":[{"code":"Px00030112476","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTI-CENTROMERE ANTIBODY","code_information":[{"code":"Px00030112483","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GLUCOSE-CSF","code_information":[{"code":"Px00030112507","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KAPPA LIGHT CHAIN","code_information":[{"code":"Px00030112517","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":109.0,"discounted_cash":76.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN-FLUID","code_information":[{"code":"Px00030112532","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URIC ACID BODY FLUID","code_information":[{"code":"Px00030112538","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5 HIAA LAB","code_information":[{"code":"Px00030112542","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOL RECEP BLOCK AB","code_information":[{"code":"Px00030112543","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030112591","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC PTH INTACT","code_information":[{"code":"Px00030112635","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DESOXYCORTICOSTERONE","code_information":[{"code":"Px00030112647","type":"CDM"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030112650","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PTH","code_information":[{"code":"Px00030112655","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":326.0,"discounted_cash":228.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TROPONIN I","code_information":[{"code":"Px00030112659","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":81.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TSH","code_information":[{"code":"Px00030112660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TSH(THYROID STIMULATING HORMONE)","code_information":[{"code":"Px00030112661","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UREA NITROGEN BODY FLUID","code_information":[{"code":"Px00030112662","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMYLASE (BODY FLUID)","code_information":[{"code":"Px00030112671","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE CDM","code_information":[{"code":"Px00030112672","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BUN (BLOOD UREA NITROGEN)","code_information":[{"code":"Px00030112695","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BUN POST DIALYSIS","code_information":[{"code":"Px00030112696","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM (24HR UR)","code_information":[{"code":"Px00030112697","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM (CA)","code_information":[{"code":"Px00030112698","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CATECHOLAMINES FRACT -24HR UR","code_information":[{"code":"Px00030112699","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE 24 HR URINE LAB","code_information":[{"code":"Px00030112700","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHLORIDE (CSF)","code_information":[{"code":"Px00030112701","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE OTHER SOURCE CDM","code_information":[{"code":"Px00030112702","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE-URINE RANDOM","code_information":[{"code":"Px00030112703","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CPK","code_information":[{"code":"Px00030112704","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE (24HR UR)","code_information":[{"code":"Px00030112705","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE (BODY FLUID)","code_information":[{"code":"Px00030112706","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE (RANDOM UR)","code_information":[{"code":"Px00030112707","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLYCATED PROTEIN FRUCTOSAMINE","code_information":[{"code":"Px00030112712","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FSH(FOLLICLE STIMULATE HORMONE)","code_information":[{"code":"Px00030112713","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE (BODY FLUID)","code_information":[{"code":"Px00030112716","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPEC)","code_information":[{"code":"Px00030112719","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C LAB","code_information":[{"code":"Px00030112722","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":80.0,"discounted_cash":56.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HCG (QUANTITATIVE)","code_information":[{"code":"Px00030112723","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGE","code_information":[{"code":"Px00030112727","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LACTATE DEHYDROGENASE LDH BODY FLUID LAB","code_information":[{"code":"Px00030112735","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LDH BODY FLUID","code_information":[{"code":"Px00030112736","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LUTEINIZING HORMORE (LH)","code_information":[{"code":"Px00030112737","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROALBUMIN QUANTITATIVE RANDOM","code_information":[{"code":"Px00030112744","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYOGLOBIN (SERUM)","code_information":[{"code":"Px00030112750","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYOGLOBIN (UR)","code_information":[{"code":"Px00030112751","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OSMOLALITY (UR)","code_information":[{"code":"Px00030112755","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":53.0,"discounted_cash":37.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PH (BODY FLUID)","code_information":[{"code":"Px00030112756","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":27.0,"discounted_cash":18.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM (24HR UR)","code_information":[{"code":"Px00030112758","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM(K)","code_information":[{"code":"Px00030112759","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN (CSF)","code_information":[{"code":"Px00030112761","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM (24HR UR)","code_information":[{"code":"Px00030112773","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM (RANDOM UR)","code_information":[{"code":"Px00030112774","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TESTOSTERONE-TOTAL","code_information":[{"code":"Px00030112777","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URIC ACID (24HR UR)","code_information":[{"code":"Px00030112779","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 17 - HYDROXYCORTICOSTEROID","code_information":[{"code":"Px00030112786","type":"CDM"},{"code":"83491","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":140.0,"discounted_cash":98.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 17-OH PROGESTERONE","code_information":[{"code":"Px00030112788","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":217.0,"discounted_cash":151.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030112797","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYL RECEPT BLOCKING AB","code_information":[{"code":"Px00030112801","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALDOSTERONE (SERUM)","code_information":[{"code":"Px00030112838","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":321.0,"discounted_cash":224.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030112886","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANGIOTENSIN CONVERT ENZ+C470(ACE)","code_information":[{"code":"Px00030112893","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANGIOTENSION CONVERTING ENZYME","code_information":[{"code":"Px00030112895","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030112898","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTI-GLIADIN IGG OR IGM","code_information":[{"code":"Px00030112911","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ARSENIC (BLOOD)","code_information":[{"code":"Px00030112918","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030112932","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL","code_information":[{"code":"Px00030112995","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA-HYDROXYBUTRIC ACID","code_information":[{"code":"Px00030113017","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIRUBIN - BODY FLUID","code_information":[{"code":"Px00030113022","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY LAB","code_information":[{"code":"Px00030113036","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY LAB","code_information":[{"code":"Px00030113037","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL CDM","code_information":[{"code":"Px00030113073","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL URINE","code_information":[{"code":"Px00030113078","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCIUM-UR RANDOM","code_information":[{"code":"Px00030113080","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CAPILLARY BLOOD GAS","code_information":[{"code":"Px00030113081","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CEA PANCREATIC CYST FLD","code_information":[{"code":"Px00030113094","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CELLULOSE ELP","code_information":[{"code":"Px00030113096","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE BLD CDM","code_information":[{"code":"Px00030113102","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLORIDE UR RANDOM","code_information":[{"code":"Px00030113105","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL","code_information":[{"code":"Px00030113108","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARBON DIOXIDE BICARBONATE LAB","code_information":[{"code":"Px00030113128","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COPPER-BLOOD","code_information":[{"code":"Px00030113139","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":88.0,"discounted_cash":61.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL (AM)","code_information":[{"code":"Px00030113140","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORTISOL (PM)","code_information":[{"code":"Px00030113142","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CPK W/REFLEX","code_information":[{"code":"Px00030113157","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CREATININE URINE","code_information":[{"code":"Px00030113167","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYOGLOBULINS","code_information":[{"code":"Px00030113176","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-TELOPEPTIDE CROSSLINK (CTXAR)","code_information":[{"code":"Px00030113181","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEXAMETHASONE SUPPRESSION","code_information":[{"code":"Px00030113229","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":130.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FECAL FAT QUANT","code_information":[{"code":"Px00030113309","type":"CDM"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GESTATIONAL GLUCOSE 1 HOUR","code_information":[{"code":"Px00030113354","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLOMERULAR BASE MEMBRAN AB-IGG","code_information":[{"code":"Px00030113360","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE (CSF)","code_information":[{"code":"Px00030113366","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE FASTING","code_information":[{"code":"Px00030113373","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","code_information":[{"code":"Px00030113377","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE TOL-1 HR-OB","code_information":[{"code":"Px00030113381","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLUCOSE URINE LAB","code_information":[{"code":"Px00030113387","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030113400","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC HCG QUANT","code_information":[{"code":"Px00030113402","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":129.0,"discounted_cash":90.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEAVY METAL QUANTIATIVE EACH NES LAB","code_information":[{"code":"Px00030113413","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEMOGLOBIN CHROMOTOGRAPHY A2","code_information":[{"code":"Px00030113418","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN-PLASMA","code_information":[{"code":"Px00030113424","type":"CDM"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HSV WESTERN BLOT","code_information":[{"code":"Px00030113464","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":520.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY NON-RIA","code_information":[{"code":"Px00030113496","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030113497","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN A (IGA)","code_information":[{"code":"Px00030113504","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030113510","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN G (IGG)","code_information":[{"code":"Px00030113511","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOGLOBULIN M (IGM)","code_information":[{"code":"Px00030113514","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSULIN TOTAL","code_information":[{"code":"Px00030113522","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF IRON CDM","code_information":[{"code":"Px00030113527","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030113541","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CSF","code_information":[{"code":"Px00030113554","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":50.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEAD-BLOOD(OSHA)","code_information":[{"code":"Px00030113571","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MAGNESIUM (24HR UR)","code_information":[{"code":"Px00030113581","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030113587","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MERCURY BLD","code_information":[{"code":"Px00030113605","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC METANEPHRINES-PLASMA","code_information":[{"code":"Px00030113624","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OLIGOCL BANDS CSF/SERUM (OLIGB)","code_information":[{"code":"Px00030113718","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":112.0,"discounted_cash":78.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ORGANIC ACIDS QUANT EACH","code_information":[{"code":"Px00030113727","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY","code_information":[{"code":"Px00030113740","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHORUS INORGANIC URINE","code_information":[{"code":"Px00030113750","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PHOSPHORUS INORGANIC RANDOM URINE LAB","code_information":[{"code":"Px00030113752","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PKU NEWBORN SCREEN","code_information":[{"code":"Px00030113753","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PORPHOBILINOGEN RANDON URINE","code_information":[{"code":"Px00030113758","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PORPHYNRINS URINE RANDOM","code_information":[{"code":"Px00030113763","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION CDM","code_information":[{"code":"Px00030113766","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM (RANDOM UR)","code_information":[{"code":"Px00030113779","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":36.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM BODY FLUID LAB","code_information":[{"code":"Px00030113786","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROSTATIC SPECIFIC AG","code_information":[{"code":"Px00030113800","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":155.0,"discounted_cash":108.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF PROTEIN 24HR URINE LAB","code_information":[{"code":"Px00030113803","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030113810","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":142.0,"discounted_cash":99.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030113814","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORESIS-UR RANDOM","code_information":[{"code":"Px00030113816","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN OTH (24HR UR)","code_information":[{"code":"Px00030113821","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN-UR RANDOM","code_information":[{"code":"Px00030113827","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REFLEXIVE TSH","code_information":[{"code":"Px00030113885","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC APOLIPOPROTEIN EACH CDM","code_information":[{"code":"Px00030113941","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":78.0,"discounted_cash":54.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ARSENIC","code_information":[{"code":"Px00030113942","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CATECHOLAMINES FRACTIONATED LAB","code_information":[{"code":"Px00030113956","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEOXYCORTISOL 11","code_information":[{"code":"Px00030113973","type":"CDM"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030113976","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HSV BY WESTERN BLOT","code_information":[{"code":"Px00030113982","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEAD","code_information":[{"code":"Px00030114073","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM SERUM PLASMA OR WHOLE BLOOD","code_information":[{"code":"Px00030114096","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM SERUM PLASMA OR WHOLE BLOOD CDM","code_information":[{"code":"Px00030114097","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM-BODY FLUID","code_information":[{"code":"Px00030114102","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC POTASSIUM SERUM PLASMA/WHOLE BLOOD","code_information":[{"code":"Px00030114117","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC STRIATIONAL (STR MUSCLE) ABS","code_information":[{"code":"Px00030114119","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC TESTOSTERONE -TOTAL","code_information":[{"code":"Px00030114149","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030114150","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030114152","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030114160","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE TRANSGLUTAMINASE AB IGG/A","code_information":[{"code":"Px00030114177","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":93.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030114183","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":209.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":148.0,"discounted_cash":103.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TOTAL TESTOSTERONE","code_information":[{"code":"Px00030114190","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":204.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRIGLYCERIDES (BODY FLUID)","code_information":[{"code":"Px00030114195","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TROPONIN-T","code_information":[{"code":"Px00030114201","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":81.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TSH REFLEX TO FT4","code_information":[{"code":"Px00030114208","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TSH REFLEXIVE","code_information":[{"code":"Px00030114209","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UMBILICA VEIN BLOOD GAS","code_information":[{"code":"Px00030114215","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UMBILICAL ARTERY BLOOD GAS","code_information":[{"code":"Px00030114216","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UREA NITROGEN-UR RANDOM","code_information":[{"code":"Px00030114225","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE","code_information":[{"code":"Px00030114229","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE CDM","code_information":[{"code":"Px00030114230","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD GASES W O2 SATURATION VENOUS LAB","code_information":[{"code":"Px00030114253","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":97.0,"discounted_cash":67.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB","code_information":[{"code":"Px00030114260","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":235.0,"discounted_cash":164.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","code_information":[{"code":"Px00030114263","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":235.0,"discounted_cash":164.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SODIUM URINE RANDOM","code_information":[{"code":"Px00030114284","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2 ACETAMINOPHEN","code_information":[{"code":"Px00030114302","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 NORTRIPTYLINE LAB","code_information":[{"code":"Px00030114303","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 DESIPRAMINE","code_information":[{"code":"Px00030114304","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 AMITRIPTYLINE LAB","code_information":[{"code":"Px00030114306","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF OPIATES","code_information":[{"code":"Px00030114313","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030114357","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC METHYL ALCOHOL","code_information":[{"code":"Px00030114358","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS","code_information":[{"code":"Px00030114380","type":"CDM"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS","code_information":[{"code":"Px00030114395","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 8 PER DOS","code_information":[{"code":"Px00030114398","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TESTOSTERONE BIOAVAILABLE","code_information":[{"code":"Px00030114407","type":"CDM"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200108","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200109","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200113","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":183.0,"discounted_cash":128.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200114","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200117","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":309.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INHIBIN A","code_information":[{"code":"Px00030200120","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200124","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200125","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200126","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200127","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":175.0,"discounted_cash":122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200130","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200133","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200134","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200136","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030200138","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":175.0,"discounted_cash":122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200142","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030200143","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB","code_information":[{"code":"Px00030200149","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":676.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":707.0,"discounted_cash":494.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200152","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200153","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":119.0,"discounted_cash":83.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200171","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200172","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200173","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200174","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL LAB","code_information":[{"code":"Px00030200202","type":"CDM"},{"code":"86831","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION LAB","code_information":[{"code":"Px00030200207","type":"CDM"},{"code":"86825","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":583.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA","code_information":[{"code":"Px00030200219","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES LAB","code_information":[{"code":"Px00030200220","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200221","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200223","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200224","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200225","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200226","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":120.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200280","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200295","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200296","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200297","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MITOCHONDRIAL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200300","type":"CDM"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200314","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200320","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200345","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIEDLAB","code_information":[{"code":"Px00030200355","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIEDLAB","code_information":[{"code":"Px00030200356","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200358","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030200364","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200365","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200414","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":165.0,"discounted_cash":115.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200415","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200418","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSULIN ANTIBODIES LAB","code_information":[{"code":"Px00030200419","type":"CDM"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOLOGY PROCEDURE LAB","code_information":[{"code":"Px00030200420","type":"CDM"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200429","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200452","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200453","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":127.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200464","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200498","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200499","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200500","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200502","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200504","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200505","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200508","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200511","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200512","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200514","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200515","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200516","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030200517","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":162.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM LAB","code_information":[{"code":"Px00030200526","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":256.0,"discounted_cash":179.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200530","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200532","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200533","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200534","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":309.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200535","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200536","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200537","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200538","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200539","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200540","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":676.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":707.0,"discounted_cash":494.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200541","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":676.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":707.0,"discounted_cash":494.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200542","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":676.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":707.0,"discounted_cash":494.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200543","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030200544","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030200545","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HEP DELTA AGENT LAB","code_information":[{"code":"Px00030200550","type":"CDM"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":199.0,"discounted_cash":139.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 LAB","code_information":[{"code":"Px00030200551","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 LAB","code_information":[{"code":"Px00030200552","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200553","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200554","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY PROTOZOA NES LAB","code_information":[{"code":"Px00030200556","type":"CDM"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200558","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200559","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200560","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200561","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200562","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":163.0,"discounted_cash":114.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030200563","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":183.0,"discounted_cash":128.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030200564","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":163.0,"discounted_cash":114.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200644","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200655","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB","code_information":[{"code":"Px00030200656","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":676.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":707.0,"discounted_cash":494.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200668","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200669","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200670","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200671","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY BLASTOMYCES LAB","code_information":[{"code":"Px00030200674","type":"CDM"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":136.0,"discounted_cash":95.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200676","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":163.0,"discounted_cash":114.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200680","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","code_information":[{"code":"Px00030200681","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200682","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":124.0,"discounted_cash":86.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200683","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":165.0,"discounted_cash":115.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200684","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200685","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200686","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":124.0,"discounted_cash":86.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200687","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200688","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":165.0,"discounted_cash":115.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY","code_information":[{"code":"Px00030200689","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":165.0,"discounted_cash":115.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200717","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200737","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200738","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200773","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200779","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":147.0,"discounted_cash":102.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200821","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200822","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200829","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200830","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACETYLCHOLN RCPTR MODLG ANTB LAB","code_information":[{"code":"Px00030200831","type":"CDM"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACTIN SMOOTH MUSCLE ANTIBODY EACH LAB","code_information":[{"code":"Px00030200882","type":"CDM"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200883","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200899","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200990","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200991","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY BARTONELLA","code_information":[{"code":"Px00030201008","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY BARTONELLA","code_information":[{"code":"Px00030201009","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH LAB","code_information":[{"code":"Px00030201014","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT LAB","code_information":[{"code":"Px00030201027","type":"CDM"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":544.0,"discounted_cash":380.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030201046","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030210035","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY RUBELLA LAB","code_information":[{"code":"Px00030210036","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN S QUANT","code_information":[{"code":"Px00030210086","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA LAB","code_information":[{"code":"Px00030210107","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGG","code_information":[{"code":"Px00030210108","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACE-CSF","code_information":[{"code":"Px00030210115","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGG SUBCLASSES ADD CHG","code_information":[{"code":"Px00030210142","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030210148","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LAMELLAR BODIES","code_information":[{"code":"Px00030210151","type":"CDM"},{"code":"83664","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN S FUNCTION (ACTIVITY)","code_information":[{"code":"Px00030210164","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY SCREEN (OF PANEL)","code_information":[{"code":"Px00030210179","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HIV-1 AG W/HIV-1 & HIV-2 AB","code_information":[{"code":"Px00030210183","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY BARTONELLA LAB","code_information":[{"code":"Px00030210188","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030210195","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":179.0,"discounted_cash":125.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","code_information":[{"code":"Px00030210230","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030210243","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":74.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030210247","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":301.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":252.0,"discounted_cash":176.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030210248","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB","code_information":[{"code":"Px00030210249","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB","code_information":[{"code":"Px00030210250","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210253","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210254","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210255","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":195.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210256","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":195.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST QUANTITATIVE LAB","code_information":[{"code":"Px00030210272","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":48.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALLERGEN SPECIFIC IGE","code_information":[{"code":"Px00030210302","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION LAB","code_information":[{"code":"Px00030210331","type":"CDM"},{"code":"86976","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.39,"discounted_cash":54.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ASPERGILLUS GLACTO AG EIA(ARUP)","code_information":[{"code":"Px00030210337","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BARTONELLA ANTIBODY","code_information":[{"code":"Px00030210339","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY MYCOPLSM CDM","code_information":[{"code":"Px00030210350","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":134.0,"discounted_cash":93.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY LAB","code_information":[{"code":"Px00030210353","type":"CDM"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES (ANA) TITER","code_information":[{"code":"Px00030210354","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030210360","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030210361","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":163.0,"discounted_cash":114.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES - ANA","code_information":[{"code":"Px00030210369","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY ABSORPTION","code_information":[{"code":"Px00030210372","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTISTREPTOLYSIN O TITER","code_information":[{"code":"Px00030210393","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY IGG","code_information":[{"code":"Px00030210395","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTISTREPTOLYSIN O SCREEN LAB","code_information":[{"code":"Px00030210396","type":"CDM"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY IGG LAB","code_information":[{"code":"Px00030210398","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":301.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":252.0,"discounted_cash":176.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN","code_information":[{"code":"Px00030210399","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BETA 2 GLYCOPROTEIN ANTIBODY - IGA","code_information":[{"code":"Px00030210404","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY","code_information":[{"code":"Px00030210405","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030210406","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":147.0,"discounted_cash":102.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS CDM","code_information":[{"code":"Px00030210408","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030210409","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOLIPIN ANTIBODY - IGA","code_information":[{"code":"Px00030210412","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":291.0,"discounted_cash":203.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT C1 ESTERASE INHIBITOR CDM","code_information":[{"code":"Px00030210416","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT TOTAL HEMOLYTIC CDM","code_information":[{"code":"Px00030210418","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":235.0,"discounted_cash":164.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOSPHOLIPID ANTIBODY","code_information":[{"code":"Px00030210419","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":186.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLD AGGLUTININ TITER CDM","code_information":[{"code":"Px00030210424","type":"CDM"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":95.0,"discounted_cash":66.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030210428","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN - C3","code_information":[{"code":"Px00030210429","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN - C4","code_information":[{"code":"Px00030210430","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTI-DNA QUANTITATIVE","code_information":[{"code":"Px00030210432","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN2 - C1 ESTERASE INHB","code_information":[{"code":"Px00030210443","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN2 - C3","code_information":[{"code":"Px00030210445","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN2 - C4","code_information":[{"code":"Px00030210447","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT","code_information":[{"code":"Px00030210454","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN","code_information":[{"code":"Px00030210459","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA ANTIBODY - IGG","code_information":[{"code":"Px00030210467","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":162.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA ANTIBODY","code_information":[{"code":"Px00030210468","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":162.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTI-SSDNA QUANTITATIVE","code_information":[{"code":"Px00030210473","type":"CDM"},{"code":"86226","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SSA","code_information":[{"code":"Px00030210487","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANT","code_information":[{"code":"Px00030210522","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HTLV/HIV CONFIRMATORY TEST - W BLOT","code_information":[{"code":"Px00030210523","type":"CDM"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HERPES SIMPLEX TEST - TYPE 1 IGG","code_information":[{"code":"Px00030210524","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SCL 70","code_information":[{"code":"Px00030210527","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SSB","code_information":[{"code":"Px00030210534","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY","code_information":[{"code":"Px00030210537","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HETEROPHILE ANTIBODIES","code_information":[{"code":"Px00030210538","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN TETANUS CDM","code_information":[{"code":"Px00030210544","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TETANUS AB (PANL)","code_information":[{"code":"Px00030210545","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":157.0,"discounted_cash":109.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS","code_information":[{"code":"Px00030210547","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT AB QUAN HEP B CDM","code_information":[{"code":"Px00030210564","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":124.0,"discounted_cash":86.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRINSIC FACTOR ANTIBODIES CDM","code_information":[{"code":"Px00030210572","type":"CDM"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRINSIC FACTOR ANTIBODY-AB","code_information":[{"code":"Px00030210573","type":"CDM"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PARTICLE AGGLUTINATION TEST - CRYPTOCOCCUS","code_information":[{"code":"Px00030210577","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":112.0,"discounted_cash":78.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR","code_information":[{"code":"Px00030210590","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM","code_information":[{"code":"Px00030210598","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":676.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":707.0,"discounted_cash":494.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL","code_information":[{"code":"Px00030210605","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - VDRL","code_information":[{"code":"Px00030210607","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASPERGILLUS ANTIBODY - AB ID","code_information":[{"code":"Px00030210615","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASPERGILLUS ANTIBODY","code_information":[{"code":"Px00030210616","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS","code_information":[{"code":"Px00030210619","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY BRUCELLA CDM","code_information":[{"code":"Px00030210627","type":"CDM"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030210636","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":138.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COCCIDIOIDES ANTIBODY","code_information":[{"code":"Px00030210650","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY COCCIDIOIDES CDM","code_information":[{"code":"Px00030210651","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COCCIDIOIDES ANTIBODY - CSF","code_information":[{"code":"Px00030210655","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":134.0,"discounted_cash":93.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY COCCIDIOIDES CDM","code_information":[{"code":"Px00030210657","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":134.0,"discounted_cash":93.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COCCIDIOIDES ANTIBODY LAB","code_information":[{"code":"Px00030210662","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":74.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY DIPHTHERIA LAB","code_information":[{"code":"Px00030210664","type":"CDM"},{"code":"86648","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":144.0,"discounted_cash":100.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY ENTEROVIRUS CDM","code_information":[{"code":"Px00030210666","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FUNGUS ANTIBODY","code_information":[{"code":"Px00030210707","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030210708","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC HIV-1","code_information":[{"code":"Px00030210715","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":157.0,"discounted_cash":109.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RAPID HIV 1-2","code_information":[{"code":"Px00030210718","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":157.0,"discounted_cash":109.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEP B CORE (IGG-IGM) ANTIBODY","code_information":[{"code":"Px00030210728","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEP B SURFACE ANTIBODY AB QUANT","code_information":[{"code":"Px00030210730","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":124.0,"discounted_cash":86.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB CDM","code_information":[{"code":"Px00030210735","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":124.0,"discounted_cash":86.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB CDM","code_information":[{"code":"Px00030210737","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210744","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTOZOA ANTIBODY NOS","code_information":[{"code":"Px00030210750","type":"CDM"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RICKETTSIA ANTIBODY - ROCKY MT SPOTTED FEVER","code_information":[{"code":"Px00030210759","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RICKETTSIA ANTIBODY-IGM","code_information":[{"code":"Px00030210761","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":223.0,"discounted_cash":156.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RUBELLA ANTIBODY IGM","code_information":[{"code":"Px00030210763","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210765","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RUBELLA ANTIBODY","code_information":[{"code":"Px00030210766","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210767","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210769","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY WEST NILE VIRUS IGM CDM","code_information":[{"code":"Px00030210773","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":195.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC WEST NILE VIRUS AB IGM - AB IGM","code_information":[{"code":"Px00030210774","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":171.0,"discounted_cash":119.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY WEST NILE VIRUS CDM","code_information":[{"code":"Px00030210775","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY WEST NILE VIRUS CDM","code_information":[{"code":"Px00030210776","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VIRUS ANTIBODY NOS - PARAINFLUENZA 2","code_information":[{"code":"Px00030210783","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030210798","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":165.0,"discounted_cash":115.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030210822","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE LAB","code_information":[{"code":"Px00030210867","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLASMA FRESH FROZEN","code_information":[{"code":"Px00030210874","type":"CDM"},{"code":"86927","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":820.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":308.0,"discounted_cash":215.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPONENT POOLING","code_information":[{"code":"Px00030210877","type":"CDM"},{"code":"86965","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA","code_information":[{"code":"Px00030210878","type":"CDM"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.2,"discounted_cash":124.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT LAB","code_information":[{"code":"Px00030210880","type":"CDM"},{"code":"86985","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":179.0,"discounted_cash":125.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASPERGILLUS AG EIA","code_information":[{"code":"Px00030210891","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTIBODY HTLV 1 AND 2  CDM","code_information":[{"code":"Px00030210894","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HIV-1 ANTIGEN","code_information":[{"code":"Px00030210895","type":"CDM"},{"code":"87390","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFLUENZA A ANTIGEN ONLY","code_information":[{"code":"Px00030210897","type":"CDM"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INFLUENZA B ANTIGEN ONLY","code_information":[{"code":"Px00030210898","type":"CDM"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALLERGEN SPECIFIC IGE - IGE QUANT","code_information":[{"code":"Px00030210904","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIGEN TYPING-UNIT","code_information":[{"code":"Px00030210908","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING IMMUNFLUORESCENT","code_information":[{"code":"Px00030210911","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":66.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210913","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210916","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET ANTIBODIES - SEROTONIN RELEASE","code_information":[{"code":"Px00030210921","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":174.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHYSICIAN BLOOD BANK SERVICE - TRANSFUSION REACTION","code_information":[{"code":"Px00030210923","type":"CDM"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":544.0,"discounted_cash":380.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUANTIFERON TB GOLD","code_information":[{"code":"Px00030210934","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":676.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":707.0,"discounted_cash":494.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - CSF","code_information":[{"code":"Px00030210935","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL RPR","code_information":[{"code":"Px00030210936","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREP QUANT","code_information":[{"code":"Px00030210938","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":52.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM","code_information":[{"code":"Px00030210943","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB","code_information":[{"code":"Px00030210944","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CMV PCR QUALITATIVE","code_information":[{"code":"Px00030210986","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DETECT AGENT NOS-DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030210995","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA PROBE EACH (MMFSH)","code_information":[{"code":"Px00030211000","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENTEROVIRUS PCR","code_information":[{"code":"Px00030211001","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211005","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030211006","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":383.0,"discounted_cash":268.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HEPATITIS B VIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030211009","type":"CDM"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEP C PCR (QUAL)","code_information":[{"code":"Px00030211012","type":"CDM"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":599.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEP C PCR (QUANT)","code_information":[{"code":"Px00030211013","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":908.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPATITIS C GENOTYPING","code_information":[{"code":"Px00030211015","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3171.0,"discounted_cash":2219.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3225.0,"discounted_cash":2257.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HERPES SIMPLEX PCR","code_information":[{"code":"Px00030211017","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3171.0,"discounted_cash":2219.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3225.0,"discounted_cash":2257.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HIV STANDARD PCR","code_information":[{"code":"Px00030211019","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":735.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1068.0,"discounted_cash":747.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HIV ULTRA SENSITIVE PCR","code_information":[{"code":"Px00030211020","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":1124.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1068.0,"discounted_cash":747.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HSV PCR TYPING","code_information":[{"code":"Px00030211029","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","code_information":[{"code":"Px00030211031","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFLUENZA A SCREEN","code_information":[{"code":"Px00030211038","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFLUENZA B SCREEN","code_information":[{"code":"Px00030211041","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRSA PCR","code_information":[{"code":"Px00030211050","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYCOPLASMA PCR","code_information":[{"code":"Px00030211052","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211053","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211054","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA S AUREUS AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211062","type":"CDM"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030211075","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - NEURONAL","code_information":[{"code":"Px00030211076","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"Px00030211079","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":265.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00030211081","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":309.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LYME DISEASE ANTIBODY - IGG-IGM","code_information":[{"code":"Px00030211082","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":197.0,"discounted_cash":137.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYCOPLASMA ANTIBODY - IGG","code_information":[{"code":"Px00030211086","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEP C AB TEST CONFIRM","code_information":[{"code":"Px00030211089","type":"CDM"},{"code":"86804","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":178.0,"discounted_cash":124.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030211109","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030211124","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":139.0,"discounted_cash":97.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTISTREPTOLYSIN O TITER - STREPTOZYME TITER","code_information":[{"code":"Px00030211128","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - RNP","code_information":[{"code":"Px00030211132","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC RUBEOLA ANTIBODY - IGG","code_information":[{"code":"Px00030211133","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CROSSMATCH 1 UNIT","code_information":[{"code":"Px00030211144","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030211146","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030211158","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY IGM MULTI STEP PROCESS","code_information":[{"code":"Px00030211174","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL","code_information":[{"code":"Px00030211190","type":"CDM"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":1532.0,"discounted_cash":1072.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030211229","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030211230","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL","code_information":[{"code":"Px00030211342","type":"CDM"},{"code":"86828","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INFLUENZA A-B PCR","code_information":[{"code":"Px00030211511","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":655.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD COUNT RED BLOOD CELL AUTOMATED LAB","code_information":[{"code":"Px00030500013","type":"CDM"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":20.0,"discounted_cash":14.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST","code_information":[{"code":"Px00030500014","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHROMOGENIC SUBSTRATE ASSAY","code_information":[{"code":"Px00030500037","type":"CDM"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","code_information":[{"code":"Px00030500041","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","code_information":[{"code":"Px00030500042","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030500043","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED","code_information":[{"code":"Px00030500044","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":30.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500045","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EUGLOBULIN LYSIS LAB","code_information":[{"code":"Px00030500046","type":"CDM"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPARIN ASSAY LAB","code_information":[{"code":"Px00030500048","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500049","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500050","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT LAB","code_information":[{"code":"Px00030500051","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHROMOGENIC SUBSTRATE ASSAY LAB","code_information":[{"code":"Px00030500052","type":"CDM"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOGENIC SUBSTRATE ASSAY LAB","code_information":[{"code":"Px00030500061","type":"CDM"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOGENIC SUBSTRATE ASSAY LAB","code_information":[{"code":"Px00030500062","type":"CDM"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR IX PTC/CHRISTMAS LAB","code_information":[{"code":"Px00030500063","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","code_information":[{"code":"Px00030500066","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBIN TIME TITER","code_information":[{"code":"Px00030500085","type":"CDM"},{"code":"85675","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THROMBIN TIME TITER LAB","code_information":[{"code":"Px00030500086","type":"CDM"},{"code":"85675","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEPARIN NEUTRALIZATION","code_information":[{"code":"Px00030500087","type":"CDM"},{"code":"85525","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":73.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR II PROTHROMBIN SPECIFIC LAB","code_information":[{"code":"Px00030500088","type":"CDM"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500089","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR LAB","code_information":[{"code":"Px00030500090","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500091","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR LAB","code_information":[{"code":"Px00030500092","type":"CDM"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500093","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR X STUART-PROWER LAB","code_information":[{"code":"Px00030500094","type":"CDM"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500095","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR XI PTA LAB","code_information":[{"code":"Px00030500096","type":"CDM"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500097","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR XII HAGEMAN LAB","code_information":[{"code":"Px00030500098","type":"CDM"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":127.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500099","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT LAB","code_information":[{"code":"Px00030500100","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT LAB","code_information":[{"code":"Px00030500101","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500105","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":30.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT LAB","code_information":[{"code":"Px00030500111","type":"CDM"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500136","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030500137","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN","code_information":[{"code":"Px00030500138","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500141","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500142","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500144","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500145","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500146","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED LAB","code_information":[{"code":"Px00030500147","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500148","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":30.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","code_information":[{"code":"Px00030500153","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500154","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500155","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY LAB","code_information":[{"code":"Px00030500156","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500168","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500169","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500190","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":118.0,"discounted_cash":82.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500214","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500243","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500244","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030510005","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510006","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COAGULATION TIME ACTIVATED LAB","code_information":[{"code":"Px00030510013","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUCROSE LYSIS","code_information":[{"code":"Px00030510014","type":"CDM"},{"code":"85555","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR LAB","code_information":[{"code":"Px00030510015","type":"CDM"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED","code_information":[{"code":"Px00030510020","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRINOGEN ACTIVITY","code_information":[{"code":"Px00030510021","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":53.0,"discounted_cash":37.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT CDM","code_information":[{"code":"Px00030510022","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"Px00030510023","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"Px00030510024","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLEEDING TIME TEST LAB","code_information":[{"code":"Px00030510025","type":"CDM"},{"code":"85002","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":30.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB","code_information":[{"code":"Px00030510029","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":51.0,"discounted_cash":35.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AUTOMATED PLATELET COUNT","code_information":[{"code":"Px00030510030","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":30.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030510032","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL","code_information":[{"code":"Px00030510033","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BL SMEAR W/DIFF WBC COUNT","code_information":[{"code":"Px00030510034","type":"CDM"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VISCOSITY CDM","code_information":[{"code":"Px00030510035","type":"CDM"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"Px00030510038","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR IX TEST","code_information":[{"code":"Px00030510040","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPUN MICROHEMATOCRIT","code_information":[{"code":"Px00030510041","type":"CDM"},{"code":"85013","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510042","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":33.0,"discounted_cash":23.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT INHIBITOR ASSAY","code_information":[{"code":"Px00030510043","type":"CDM"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":76.0,"discounted_cash":53.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ANTIGEN LAB","code_information":[{"code":"Px00030510046","type":"CDM"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":79.0,"discounted_cash":55.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510049","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":91.0,"discounted_cash":63.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBIN TIME","code_information":[{"code":"Px00030510050","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTITHROMBIN III TEST ANITGEN","code_information":[{"code":"Px00030510051","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":71.0,"discounted_cash":49.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR V TEST","code_information":[{"code":"Px00030510052","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":107.0,"discounted_cash":74.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR II TEST","code_information":[{"code":"Px00030510054","type":"CDM"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPTILASE TEST CDM","code_information":[{"code":"Px00030510056","type":"CDM"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTHROMBIN TEST","code_information":[{"code":"Px00030510058","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR XII TEST","code_information":[{"code":"Px00030510059","type":"CDM"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":127.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY LAB","code_information":[{"code":"Px00030510060","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLETE CBC AUTOMATED","code_information":[{"code":"Px00030510062","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510063","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":53.0,"discounted_cash":37.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRINOGEN TEST LAB","code_information":[{"code":"Px00030510064","type":"CDM"},{"code":"85366","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR VIII TEST ANTIGEN","code_information":[{"code":"Px00030510065","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRIN DEGRADATION QUANT","code_information":[{"code":"Px00030510069","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":67.0,"discounted_cash":46.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE CDM","code_information":[{"code":"Px00030510071","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD CLOT FACTOR VIII TEST FACTOR","code_information":[{"code":"Px00030510072","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EUGLOBULIN LYSIS LAB","code_information":[{"code":"Px00030510073","type":"CDM"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY CDM","code_information":[{"code":"Px00030510074","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":91.0,"discounted_cash":63.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC SED RATE AUTOMATED","code_information":[{"code":"Px00030510076","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":19.0,"discounted_cash":13.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AUTOMATED RBC COUNT","code_information":[{"code":"Px00030510077","type":"CDM"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":20.0,"discounted_cash":14.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"Px00030510082","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":30.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE CDM","code_information":[{"code":"Px00030510083","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY CDM","code_information":[{"code":"Px00030510084","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510092","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":33.0,"discounted_cash":23.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMOGLOBIN BODY FLUID","code_information":[{"code":"Px00030510110","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DILUTE RUSL VIPER VENOM","code_information":[{"code":"Px00030510115","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":63.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PTT MIXING STUDIES","code_information":[{"code":"Px00030510130","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510133","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510141","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510144","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC WBC","code_information":[{"code":"Px00030510147","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":17.0,"discounted_cash":11.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT","code_information":[{"code":"Px00030510149","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY CDM","code_information":[{"code":"Px00030510152","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANTI-THROMBIN III ACTIVITY","code_information":[{"code":"Px00030510153","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY PLASMA HEMOGLOBIN","code_information":[{"code":"Px00030510158","type":"CDM"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FETAL CELL STAIN QUANT","code_information":[{"code":"Px00030510193","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":17.0,"discounted_cash":11.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRINOLYTIC PLASMINOGEN 2","code_information":[{"code":"Px00030510196","type":"CDM"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":43.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME WHOLE BLOOD","code_information":[{"code":"Px00030510203","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510207","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":91.0,"discounted_cash":63.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION EA AGENT","code_information":[{"code":"Px00030510217","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT LAB","code_information":[{"code":"Px00030510219","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510233","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AC PROTIME","code_information":[{"code":"Px00030510236","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME CDM","code_information":[{"code":"Px00030510238","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR LAB","code_information":[{"code":"Px00030510244","type":"CDM"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PTT 1 TO 1 MIX","code_information":[{"code":"Px00030510252","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FIBRINOGEN ACTIVITY LAB","code_information":[{"code":"Px00030510255","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":53.0,"discounted_cash":37.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030510287","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":38.0,"discounted_cash":26.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC WBC AUTO","code_information":[{"code":"Px00030510310","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":17.0,"discounted_cash":11.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP B LAB","code_information":[{"code":"Px00030510311","type":"CDM"},{"code":"87802","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":91.0,"discounted_cash":63.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S TOTAL LAB","code_information":[{"code":"Px00030510354","type":"CDM"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":76.0,"discounted_cash":53.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510355","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS JOINT FLUID","code_information":[{"code":"Px00030510409","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CORONAVIRUS AG IA LAB","code_information":[{"code":"Px00030600007","type":"CDM"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NFCT DS 22TRGT SARS-COV-2 BIOFIRE LAB","code_information":[{"code":"Px00030600009","type":"CDM"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1331.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB","code_information":[{"code":"Px00030600052","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":867.0,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":881.0,"discounted_cash":616.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM LAB","code_information":[{"code":"Px00030600094","type":"CDM"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","code_information":[{"code":"Px00030600149","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030600150","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600155","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600156","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600157","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600158","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600159","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600160","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600161","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600162","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600163","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600164","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600165","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600166","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600167","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600168","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600169","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600170","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600171","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600172","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600173","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600174","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600175","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600236","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030600237","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS LAB","code_information":[{"code":"Px00030600281","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":469.0,"discounted_cash":328.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600285","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":60.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ADENOVIRUS DNA QUANTITATIVE RT-PCR LAB","code_information":[{"code":"Px00030600288","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BK VIRUS QUANTITATIVE URINE LAB","code_information":[{"code":"Px00030600291","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"discounted_cash":640.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","code_information":[{"code":"Px00030600302","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":105.0,"discounted_cash":73.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BK VIRUS PLASMA QUANT PCR LAB","code_information":[{"code":"Px00030600317","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":469.0,"discounted_cash":328.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB LAB","code_information":[{"code":"Px00030600318","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ORTHOPOXVIRUS AMP PRB EACH LAB","code_information":[{"code":"Px00030600321","type":"CDM"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADI LEGIONELLA PNEUMOPHILA LAB","code_information":[{"code":"Px00030600328","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL LAB","code_information":[{"code":"Px00030600332","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":120.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","code_information":[{"code":"Px00030600333","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":120.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600372","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":60.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE LAB","code_information":[{"code":"Px00030600379","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":251.0,"discounted_cash":175.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600380","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS LAB","code_information":[{"code":"Px00030600382","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS","code_information":[{"code":"Px00030600383","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600384","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600386","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600388","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600390","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600391","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":1124.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1068.0,"discounted_cash":747.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600392","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":1124.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1068.0,"discounted_cash":747.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600394","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600400","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600403","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600404","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600405","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600406","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3171.0,"discounted_cash":2219.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3225.0,"discounted_cash":2257.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","code_information":[{"code":"Px00030600409","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3171.0,"discounted_cash":2219.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3225.0,"discounted_cash":2257.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3171.0,"discounted_cash":2219.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3225.0,"discounted_cash":2257.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3171.0,"discounted_cash":2219.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3225.0,"discounted_cash":2257.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600417","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":1124.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1068.0,"discounted_cash":747.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3171.0,"discounted_cash":2219.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3225.0,"discounted_cash":2257.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING ID BLD PTHGN&RESIST TYPING GTE 6 TRGT LAB","code_information":[{"code":"Px00030600419","type":"CDM"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.0,"discounted_cash":1024.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600431","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600432","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600435","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE","code_information":[{"code":"Px00030600449","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":251.0,"discounted_cash":175.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":60.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL LAB","code_information":[{"code":"Px00030600527","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":49.0,"discounted_cash":34.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HOMOGENIZATION TISSUE CULTURE LAB","code_information":[{"code":"Px00030600528","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600529","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600533","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600619","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ LAB","code_information":[{"code":"Px00030600699","type":"CDM"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":739.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600749","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":330.0,"discounted_cash":231.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URINE BACTERIA CULTURE 2ND ORG","code_information":[{"code":"Px00030610050","type":"CDM"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610058","type":"CDM"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610059","type":"CDM"},{"code":"87511","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1807.0,"discounted_cash":1264.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100U","code_information":[{"code":"Px00030610080","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":463.0,"discounted_cash":324.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100U","code_information":[{"code":"Px00030610081","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":463.0,"discounted_cash":324.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100U","code_information":[{"code":"Px00030610082","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":463.0,"discounted_cash":324.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA RESPIRATRY PROBE AND REV TRNSCR 21 TARGET PLA BIOFIRE PLA 0100","code_information":[{"code":"Px00030610083","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.0,"discounted_cash":1099.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1571.0,"discounted_cash":1099.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610091","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":402.0,"discounted_cash":281.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030610092","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610093","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":402.0,"discounted_cash":281.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION LAB","code_information":[{"code":"Px00030610094","type":"CDM"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":437.0,"discounted_cash":305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEPATITIS C GENOTYPING EXTRACT","code_information":[{"code":"Px00030610101","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HIV-1 RNA BY BRANCHED DNA","code_information":[{"code":"Px00030610108","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":735.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1068.0,"discounted_cash":747.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610111","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HV6 DNA PCR","code_information":[{"code":"Px00030610114","type":"CDM"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":543.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INFLUENZA A AND B SCREEN","code_information":[{"code":"Px00030610118","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC N.GONORRHOEAE DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030610129","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC N.GONORRHOEAE DNA APTIMA2","code_information":[{"code":"Px00030610131","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OVA AND PARASITES EXAM","code_information":[{"code":"Px00030610133","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERTUSSIS BY PCR","code_information":[{"code":"Px00030610137","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA ROTAVIRUS CDM","code_information":[{"code":"Px00030610142","type":"CDM"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RSV DIRECT ANTIGEN","code_information":[{"code":"Px00030610144","type":"CDM"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":394.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRICHROME STAIN","code_information":[{"code":"Px00030610151","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 21 TARGET BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610152","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1365.0,"discounted_cash":955.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1365.0,"discounted_cash":955.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RSV ANTIGEN SCREEN","code_information":[{"code":"Px00030610171","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-EAR","code_information":[{"code":"Px00030610177","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM","code_information":[{"code":"Px00030610178","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610182","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":402.0,"discounted_cash":281.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610183","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":402.0,"discounted_cash":281.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS LAB","code_information":[{"code":"Px00030610189","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610191","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM LAB","code_information":[{"code":"Px00030610199","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":380.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","code_information":[{"code":"Px00030610277","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD CULTURE FOR BACTERIA","code_information":[{"code":"Px00030610301","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL CDM","code_information":[{"code":"Px00030610304","type":"CDM"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":380.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER","code_information":[{"code":"Px00030610321","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER- BODY FLUID","code_information":[{"code":"Px00030610322","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-EYE SURFACE","code_information":[{"code":"Px00030610325","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER - CSF","code_information":[{"code":"Px00030610326","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - RESPIRATORY","code_information":[{"code":"Px00030610330","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-RESPIR UPPER","code_information":[{"code":"Px00030610331","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-WOUND-SURFACE","code_information":[{"code":"Px00030610333","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-SURGICAL TISSUE","code_information":[{"code":"Px00030610337","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER - CENTRAL LINE","code_information":[{"code":"Px00030610342","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610356","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM","code_information":[{"code":"Px00030610358","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - YERSINIA","code_information":[{"code":"Px00030610382","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":55.0,"discounted_cash":38.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - HELICOBACTER PYLORI","code_information":[{"code":"Px00030610383","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - BETA STREP","code_information":[{"code":"Px00030610384","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610386","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610387","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - MRSA /MSSA","code_information":[{"code":"Px00030610391","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - PERTUSSIS","code_information":[{"code":"Px00030610409","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URINE CULTURE/COLONY COUNT","code_information":[{"code":"Px00030610417","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URINE BACTERIA CULTURE","code_information":[{"code":"Px00030610419","type":"CDM"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FUNGUS ISOLATION CULTURE - YEAST","code_information":[{"code":"Px00030610421","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":106.0,"discounted_cash":74.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-YEAST","code_information":[{"code":"Px00030610422","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":317.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":106.0,"discounted_cash":74.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FUNGUS ISOLATION CULTURE","code_information":[{"code":"Px00030610423","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":106.0,"discounted_cash":74.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","code_information":[{"code":"Px00030610426","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":523.0,"discounted_cash":366.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":116.0,"discounted_cash":81.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST LAB","code_information":[{"code":"Px00030610436","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST LAB","code_information":[{"code":"Px00030610442","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":116.0,"discounted_cash":81.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","code_information":[{"code":"Px00030610444","type":"CDM"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":135.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYCOBACTERIA CULTURE - AFB CULTURE","code_information":[{"code":"Px00030610448","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":137.0,"discounted_cash":95.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030610463","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC STREPT LAB","code_information":[{"code":"Px00030610466","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ARTHROPOD ID","code_information":[{"code":"Px00030610471","type":"CDM"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PINWORM EXAMINATION CDM","code_information":[{"code":"Px00030610477","type":"CDM"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE HOMOGENIZATION CULTR","code_information":[{"code":"Px00030610478","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":68.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROBE SUSCEPTIBLE DISK - KIRBY-BAUER","code_information":[{"code":"Px00030610490","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROBE SUSCEPTIBLE DISK - ESBL","code_information":[{"code":"Px00030610499","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":90.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610547","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ LAB","code_information":[{"code":"Px00030610551","type":"CDM"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMEAR GRAM STAIN","code_information":[{"code":"Px00030610563","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GRAM STAIN","code_information":[{"code":"Px00030610566","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KOHEXAM","code_information":[{"code":"Px00030610574","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":56.0,"discounted_cash":39.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE EXAM FOR FUNGI - HAIR/NAIL/SKIN","code_information":[{"code":"Px00030610576","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":49.0,"discounted_cash":34.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE EXAM FOR FUNGI KOH-TISSUE","code_information":[{"code":"Px00030610577","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CLOSTRIDIUM AG EIA","code_information":[{"code":"Px00030610581","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GIARDIA ANTIGEN","code_information":[{"code":"Px00030610583","type":"CDM"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA INFLUENZA A/B EACH CDM","code_information":[{"code":"Px00030610591","type":"CDM"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM CDM","code_information":[{"code":"Px00030610595","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":187.0,"discounted_cash":130.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-ANAEROBE","code_information":[{"code":"Px00030610600","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PNEUMOCOCCAL AB IGG","code_information":[{"code":"Px00030610601","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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRYPTOCOCCAL ANTIGEN SCREEN","code_information":[{"code":"Px00030610602","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":119.0,"discounted_cash":83.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE STOOL ADDITIONAL PATH","code_information":[{"code":"Px00030610606","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":121.0,"discounted_cash":84.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-RESPIR LOWER","code_information":[{"code":"Px00030610608","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-IV CATH TIP","code_information":[{"code":"Px00030610609","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-BODY FLUID","code_information":[{"code":"Px00030610610","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ","code_information":[{"code":"Px00030610623","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CULTURE-METH RESIST S AUREUS","code_information":[{"code":"Px00030610628","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":86.0,"discounted_cash":60.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FUNGUS CULTURE-OTHER","code_information":[{"code":"Px00030610638","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":106.0,"discounted_cash":74.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYCOBACTERIA CULTURE AFB BLOOD LAB","code_information":[{"code":"Px00030610646","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":137.0,"discounted_cash":95.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY - MIC","code_information":[{"code":"Px00030610651","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IAAD IA HPYLORI STOOL CDM","code_information":[{"code":"Px00030610663","type":"CDM"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AFB STAIN","code_information":[{"code":"Px00030610665","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":69.0,"discounted_cash":48.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB","code_information":[{"code":"Px00030610668","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CALCOFLUOR STAIN","code_information":[{"code":"Px00030610672","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":60.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610674","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHLAMYDIA TRACHOMATIS APTIMA2","code_information":[{"code":"Px00030610675","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CMV AMPLIFIED PROBE 2","code_information":[{"code":"Px00030610680","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN","code_information":[{"code":"Px00030610682","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENTEROVIRUS DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030610688","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":440.0,"discounted_cash":308.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENTEROVIRUS DNA AMPLIFIED PROBE BY RT","code_information":[{"code":"Px00030610689","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FUNGAL ANTIBODY","code_information":[{"code":"Px00030610691","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IADNA HEPATITIS B VIRUS QUANTIFICATION LAB","code_information":[{"code":"Px00030610698","type":"CDM"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NFCT AGENT DETECTION GI","code_information":[{"code":"Px00030610701","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":567.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY LAB","code_information":[{"code":"Px00030610706","type":"CDM"},{"code":"87625","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES CDM","code_information":[{"code":"Px00030610707","type":"CDM"},{"code":"87806","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DNA PROBE TYPE 12-25","code_information":[{"code":"Px00030610971","type":"CDM"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":5129.0,"discounted_cash":3590.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700003","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":15.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700004","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP LAB","code_information":[{"code":"Px00030700008","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":15.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700015","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":23.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700016","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":23.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00030710008","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM","code_information":[{"code":"Px00030710009","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":23.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSCOPIC EXAM OF URINE","code_information":[{"code":"Px00030710010","type":"CDM"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":22.0,"discounted_cash":15.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FAT/LIPIDS FECES QUALITATIVE CDM","code_information":[{"code":"Px00030710011","type":"CDM"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROTEIN URINE QUALITATIVE","code_information":[{"code":"Px00030710015","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16.0,"discounted_cash":11.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIFIC GRAVITY URINE","code_information":[{"code":"Px00030710023","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":15.0,"discounted_cash":10.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIFIC GRAVITY URINE","code_information":[{"code":"Px00030710033","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":18.0,"discounted_cash":12.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SEMEN ANALYSIS","code_information":[{"code":"Px00030710102","type":"CDM"},{"code":"89320","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":87.0,"discounted_cash":60.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HLA II TYPING AG EQUIV LR","code_information":[{"code":"Px00030910018","type":"CDM"},{"code":"81375","type":"HCPCS"}],"standard_charges":[{"gross_charge":1736.0,"discounted_cash":1215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT CDM","code_information":[{"code":"Px00030910102","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIMEN FAT STAIN","code_information":[{"code":"Px00030910108","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":34.0,"discounted_cash":23.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":5129.0,"discounted_cash":3590.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00031000047","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00031000060","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031000072","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":929.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3062.0,"discounted_cash":2143.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN LAB","code_information":[{"code":"Px00031000093","type":"CDM"},{"code":"80503","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT LAB","code_information":[{"code":"Px00031000104","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000107","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","code_information":[{"code":"Px00031000144","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELECTRON MICROSCOPY DIAGNOSTIC LAB","code_information":[{"code":"Px00031000146","type":"CDM"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00031000167","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":359.0,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SNRPN/UBE3A METHYLATION ANALYSIS LAB","code_information":[{"code":"Px00031000205","type":"CDM"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1349.0,"discounted_cash":944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000324","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":266.0,"discounted_cash":186.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MD SCREEN-1-SPO","code_information":[{"code":"Px00031010005","type":"CDM"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROSTATE BIOPSY ANY MTHD LAB","code_information":[{"code":"Px00031010110","type":"CDM"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION","code_information":[{"code":"Px00031010115","type":"CDM"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTP SMRS ANY OTH SRC SCR&INTERPJ","code_information":[{"code":"Px00031010116","type":"CDM"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC QUICK STAIN","code_information":[{"code":"Px00031010117","type":"CDM"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FETAL HEMOGLOBIN F BY FLOW","code_information":[{"code":"Px00031010118","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BCL2-FLOW","code_information":[{"code":"Px00031010119","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CCD22 FLOW","code_information":[{"code":"Px00031010120","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD71 FLOW","code_information":[{"code":"Px00031010121","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TCRAB FLOW","code_information":[{"code":"Px00031010122","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TCRGD FLOW","code_information":[{"code":"Px00031010123","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MDS SUREPATH PAP FOCAL POINT","code_information":[{"code":"Px00031010124","type":"CDM"},{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DNA PROBE EACH (NEOPLASTIC)","code_information":[{"code":"Px00031010126","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SCREEN CERV/VAG THIN LAYER","code_information":[{"code":"Px00031010190","type":"CDM"},{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":145.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ADDITIONAL KAROTYPE","code_information":[{"code":"Px00031010201","type":"CDM"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":189.0,"discounted_cash":132.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BAL DIFFERENTIAL TECH","code_information":[{"code":"Px00031010206","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BAL IRON STAIN","code_information":[{"code":"Px00031010207","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY BONE MARROW INTERP","code_information":[{"code":"Px00031010243","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CD103 FLOW","code_information":[{"code":"Px00031010254","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD16 FLOW","code_information":[{"code":"Px00031010255","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD2 FLOW","code_information":[{"code":"Px00031010256","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD23 FLOW","code_information":[{"code":"Px00031010257","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD24 FLOW","code_information":[{"code":"Px00031010258","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD3 FLOW","code_information":[{"code":"Px00031010259","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD4 FLOW","code_information":[{"code":"Px00031010260","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD45 FLOW","code_information":[{"code":"Px00031010261","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CD5 FLOW","code_information":[{"code":"Px00031010262","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD55 FLOW","code_information":[{"code":"Px00031010263","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD57 FLOW STANDALONE TEST","code_information":[{"code":"Px00031010264","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CD58 FLOW","code_information":[{"code":"Px00031010265","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD59 FLOW","code_information":[{"code":"Px00031010266","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD79A FLOW","code_information":[{"code":"Px00031010267","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD79B FLOW","code_information":[{"code":"Px00031010268","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CD9 FLOW","code_information":[{"code":"Px00031010269","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CDIIC FLOW","code_information":[{"code":"Px00031010270","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CELL BLOCK","code_information":[{"code":"Px00031010273","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME ANALYSIS 100 CELLS","code_information":[{"code":"Px00031010280","type":"CDM"},{"code":"88249","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.0,"discounted_cash":1493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1289.0,"discounted_cash":902.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME ANALYSIS 15-20 CELLS","code_information":[{"code":"Px00031010281","type":"CDM"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1463.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":928.0,"discounted_cash":649.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME ANALYSIS 20-25 CELLS LAB","code_information":[{"code":"Px00031010286","type":"CDM"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1463.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":928.0,"discounted_cash":649.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY LAB","code_information":[{"code":"Px00031010289","type":"CDM"},{"code":"88285","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":144.0,"discounted_cash":100.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHRMSM ANALYSIS ADDL SPECIALIZED BANDING LAB","code_information":[{"code":"Px00031010290","type":"CDM"},{"code":"88283","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":227.0,"discounted_cash":158.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME ANALYSIS ADDL SPECIALIZED BANDING2","code_information":[{"code":"Px00031010291","type":"CDM"},{"code":"88283","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":213.0,"discounted_cash":149.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY LAB","code_information":[{"code":"Px00031010292","type":"CDM"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":189.0,"discounted_cash":132.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME ANALYSIS HIGH RESOLUTION STUDY","code_information":[{"code":"Px00031010294","type":"CDM"},{"code":"88289","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":259.0,"discounted_cash":181.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","code_information":[{"code":"Px00031010297","type":"CDM"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1463.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":928.0,"discounted_cash":649.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME CULTURE HARVEST","code_information":[{"code":"Px00031010298","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":867.0,"discounted_cash":606.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CONSULT COMPREHENSIVE","code_information":[{"code":"Px00031010306","type":"CDM"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":629.0,"discounted_cash":440.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTOGENICS SETUP","code_information":[{"code":"Px00031010321","type":"CDM"},{"code":"88299","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":116.0,"discounted_cash":81.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTOPATH BETHESDA CERV/VAG MANUAL","code_information":[{"code":"Px00031010324","type":"CDM"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":460.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP SMRS ANY OTH SRC EXTND STD GT 5 SLIDES","code_information":[{"code":"Px00031010335","type":"CDM"},{"code":"88162","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP CONCENTRATION SMEARS & INTERPRETATION TECH LAB","code_information":[{"code":"Px00031010339","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP SMRS ANY OTH SRC SCR&INTERPJ LAB","code_information":[{"code":"Px00031010340","type":"CDM"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DECALCIFICATION PROCEDURE LAB","code_information":[{"code":"Px00031010341","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DERM SLIDE LTD","code_information":[{"code":"Px00031010344","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTRON MICROSCOPY DIAGNOSTIC LAB","code_information":[{"code":"Px00031010348","type":"CDM"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESTERASE","code_information":[{"code":"Px00031010352","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FETAL HEMOGLOBIN  FIRST MARKER","code_information":[{"code":"Px00031010358","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLAER FLOW","code_information":[{"code":"Px00031010363","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FMC7 FLOW","code_information":[{"code":"Px00031010369","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":438.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031010386","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","code_information":[{"code":"Px00031010400","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ISH ANALYSZE 10-30 CELLS","code_information":[{"code":"Px00031010402","type":"CDM"},{"code":"88273","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":240.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISH ANALYZE 100-300 CELLS","code_information":[{"code":"Px00031010403","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":300.0,"discounted_cash":210.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL FISH LAB","code_information":[{"code":"Px00031010404","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":300.0,"discounted_cash":210.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ISH ANALYZE 100-300 CELLS2","code_information":[{"code":"Px00031010405","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":300.0,"discounted_cash":210.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL LAB","code_information":[{"code":"Px00031010409","type":"CDM"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":592.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":262.0,"discounted_cash":183.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MDS CONVENT PAP FOCAL POINT","code_information":[{"code":"Px00031010426","type":"CDM"},{"code":"G0148","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSLIDE CONSULTATION","code_information":[{"code":"Px00031010428","type":"CDM"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSLIDE CONSULTATION W/ SLIDE PREP","code_information":[{"code":"Px00031010429","type":"CDM"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":506.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MICROSLIDE CONSULTATION W/SLIDE PREP BONE MARROW","code_information":[{"code":"Px00031010431","type":"CDM"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH FISH LAB","code_information":[{"code":"Px00031010447","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MPO FLOW","code_information":[{"code":"Px00031010456","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS","code_information":[{"code":"Px00031010462","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PAP SCREEN BY TECH","code_information":[{"code":"Px00031010465","type":"CDM"},{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PAS STAIN","code_information":[{"code":"Px00031010466","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":511.0,"discounted_cash":357.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS","code_information":[{"code":"Px00031010477","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","code_information":[{"code":"Px00031010479","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RECUT","code_information":[{"code":"Px00031010487","type":"CDM"},{"code":"88399","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IGH REARRANGE ABNORMAL CLONAL POP AMPLIFIED LAB","code_information":[{"code":"Px00031010490","type":"CDM"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPEC STAIN ID HM DPNH","code_information":[{"code":"Px00031010495","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPEC STAIN ID HM STPH 9.4","code_information":[{"code":"Px00031010496","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPEC STAIN ID NA SUCCINATE DH","code_information":[{"code":"Px00031010497","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB","code_information":[{"code":"Px00031010498","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":414.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU LAB","code_information":[{"code":"Px00031010512","type":"CDM"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":1271.0,"discounted_cash":889.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU TRICHROME","code_information":[{"code":"Px00031010513","type":"CDM"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SUDAN BLACK B STAIN","code_information":[{"code":"Px00031010517","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB","code_information":[{"code":"Px00031010519","type":"CDM"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010520","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010522","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010524","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010531","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.0,"discounted_cash":492.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":629.0,"discounted_cash":440.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010536","type":"CDM"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TDT FLOW","code_information":[{"code":"Px00031010541","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THIN PREP - NONS","code_information":[{"code":"Px00031010542","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISS CUL NON-NEO DISORDERS LYMPHOCYTE LAB","code_information":[{"code":"Px00031010546","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":867.0,"discounted_cash":606.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2366.0,"discounted_cash":1656.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1048.0,"discounted_cash":733.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE CULTURE AMNIOTIC FLUID","code_information":[{"code":"Px00031010549","type":"CDM"},{"code":"88235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2704.0,"discounted_cash":1892.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1095.0,"discounted_cash":766.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS LAB","code_information":[{"code":"Px00031010553","type":"CDM"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":2117.0,"discounted_cash":1481.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":941.0,"discounted_cash":658.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISS CUL NON-NEO DISORDERS LYMPHOCYTE","code_information":[{"code":"Px00031010554","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":1368.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":867.0,"discounted_cash":606.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE CULTURE SOLID TUMOR","code_information":[{"code":"Px00031010556","type":"CDM"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":2479.0,"discounted_cash":1735.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1099.0,"discounted_cash":769.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISSUE EXAM MOLECULAR STUDY","code_information":[{"code":"Px00031010557","type":"CDM"},{"code":"88387","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRAP STAIN","code_information":[{"code":"Px00031010561","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS","code_information":[{"code":"Px00031010563","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1824.0,"discounted_cash":1276.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED SURGICAL PATHOLOGY PROCEDURE","code_information":[{"code":"Px00031010570","type":"CDM"},{"code":"88399","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ZAP 70-FLOW","code_information":[{"code":"Px00031010574","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS 50-100 CELLS","code_information":[{"code":"Px00031010575","type":"CDM"},{"code":"88248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.0,"discounted_cash":1493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1289.0,"discounted_cash":902.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE LAB","code_information":[{"code":"Px00031010576","type":"CDM"},{"code":"88267","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":2116.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1337.0,"discounted_cash":935.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHROMOSOME ANALYSIS 20-25 CELLS","code_information":[{"code":"Px00031010578","type":"CDM"},{"code":"88245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.0,"discounted_cash":1283.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1109.0,"discounted_cash":776.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AML DNA PROBE EACH FISH","code_information":[{"code":"Px00031010583","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC B-CELL LYMPHOMA FISH DNA PROBE EACH","code_information":[{"code":"Px00031010584","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH CDM","code_information":[{"code":"Px00031010585","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH CDM","code_information":[{"code":"Px00031010586","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC B-CELL LYMPHOMA FISH 100-300 CELLS","code_information":[{"code":"Px00031010589","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":300.0,"discounted_cash":210.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL LAB","code_information":[{"code":"Px00031010594","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTOGEN M ARRAY COPY NO & SNP","code_information":[{"code":"Px00031010606","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":3062.0,"discounted_cash":2143.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOLECULAR PATH LEVEL 2","code_information":[{"code":"Px00031010608","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.0,"discounted_cash":773.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOLECULAR PATH LEVEL 3","code_information":[{"code":"Px00031010609","type":"CDM"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IGH PCR","code_information":[{"code":"Px00031010613","type":"CDM"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.0,"discounted_cash":739.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MICROSLIDE CONSULTATION W/SLIDE PREP BONE MARROW","code_information":[{"code":"Px00031010630","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTERASE COMB","code_information":[{"code":"Px00031010631","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":272.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERIODIC ACID SCHIFF (PAS)","code_information":[{"code":"Px00031010632","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":272.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTERASE SPECIFIC","code_information":[{"code":"Px00031010633","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":272.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT","code_information":[{"code":"Px00031010634","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":272.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":464.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":583.0,"discounted_cash":408.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY LAB","code_information":[{"code":"Px00031010847","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1328.0,"discounted_cash":929.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL","code_information":[{"code":"Px00031100005","type":"CDM"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","code_information":[{"code":"Px00031100010","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","code_information":[{"code":"Px00031100011","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV","code_information":[{"code":"Px00031100014","type":"CDM"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","code_information":[{"code":"Px00031100021","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MN LAB","code_information":[{"code":"Px00031100055","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100061","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP CONCENTRATE SMEARS & INTERPRETATION","code_information":[{"code":"Px00031100066","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTP CONCENTRATE SMEARS & INTERPRETATION","code_information":[{"code":"Px00031100067","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","code_information":[{"code":"Px00031100068","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","code_information":[{"code":"Px00031100069","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTP CONCENTRATION SMEARS AND INTERPRETATION LAB","code_information":[{"code":"Px00031110010","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":203.0,"discounted_cash":142.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYTO EXAM PREP EA ADD SITE","code_information":[{"code":"Px00031110011","type":"CDM"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYTO EXAM PREP INITIAL SITE","code_information":[{"code":"Px00031110012","type":"CDM"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":375.0,"discounted_cash":262.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PAP SUREPATH DIAGNOSTIC","code_information":[{"code":"Px00031110030","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PAP-THIN PREP SCREENING","code_information":[{"code":"Px00031110033","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":269.0,"discounted_cash":188.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TISS CUL NON-NEO DISORDERS LYMPHOCYTE","code_information":[{"code":"Px00031110044","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":1053.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":913.0,"discounted_cash":639.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VOLUME MEASUREMENT TIMED COLLECTION EACH CDM","code_information":[{"code":"Px00031900006","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":22.0,"discounted_cash":15.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE CDM","code_information":[{"code":"Px00031900011","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN CDM","code_information":[{"code":"Px00031900012","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":171.0,"discounted_cash":119.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00031900048","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM CDM","code_information":[{"code":"Px00031900056","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":380.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00031900068","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":32.0,"discounted_cash":22.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00031900069","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF ALDOSTERONE CDM","code_information":[{"code":"Px00031900113","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY IGA/IGD/IGG/IGM EACH (RL)","code_information":[{"code":"Px00031900137","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":75.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASSAY OF SERUM ALBUMIN (RL)","code_information":[{"code":"Px00031900138","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":41.0,"discounted_cash":28.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OLIGOCLONAL BANDS (RL)","code_information":[{"code":"Px00031900139","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":112.0,"discounted_cash":78.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT CDM","code_information":[{"code":"Px00031900176","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI(RL)","code_information":[{"code":"Px00031900180","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":567.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":62.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD CDM","code_information":[{"code":"Px00031900224","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OLIGOCLONAL IMMUNE CDM","code_information":[{"code":"Px00031900225","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":108.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00031900226","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MCG DNA PROBE EA (RL)","code_information":[{"code":"Px00031900289","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":161.0,"discounted_cash":112.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MCG IP SITU 25-99 CELLS (RL)","code_information":[{"code":"Px00031900290","type":"CDM"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":300.0,"discounted_cash":210.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MOLECULAR FLUOR IMAGING SUSPICIOUS NEVUS 1ST LES CDM","code_information":[{"code":"Px00032000002","type":"CDM"},{"code":"0700T","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOLECULAR FLUOR IMAGING SUSPICIOUS NEVUS EA ADDL CDM","code_information":[{"code":"Px00032000003","type":"CDM"},{"code":"0701T","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BS DXA/OTHER IMG CALCULATION W/I&R FX RISK CDM","code_information":[{"code":"Px00032000006","type":"CDM"},{"code":"77089","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR CDM","code_information":[{"code":"Px00032000007","type":"CDM"},{"code":"77090","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TBS TECHNICAL CALCULATION ONLY CDM","code_information":[{"code":"Px00032000008","type":"CDM"},{"code":"77091","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TBS INTERPRETATION & REPORT FX RISK BY OTHER QHP CDM","code_information":[{"code":"Px00032000009","type":"CDM"},{"code":"77092","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR MYELOGRAM POSTERIOR FOSSA","code_information":[{"code":"Px00032010001","type":"CDM"},{"code":"70010","type":"HCPCS"}],"standard_charges":[{"gross_charge":4048.0,"discounted_cash":2833.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2620.0,"discounted_cash":1834.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CISTERNOGRAM","code_information":[{"code":"Px00032010002","type":"CDM"},{"code":"70015","type":"HCPCS"}],"standard_charges":[{"gross_charge":2346.0,"discounted_cash":1642.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR EYE FOR FOREIGN BODY","code_information":[{"code":"Px00032010003","type":"CDM"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010004","type":"CDM"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MANDIBLE 1-3 VIEWS","code_information":[{"code":"Px00032010006","type":"CDM"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":935.0,"discounted_cash":654.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"Px00032010007","type":"CDM"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":763.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MASTOIDS UNI LT/3 VIEWS","code_information":[{"code":"Px00032010008","type":"CDM"},{"code":"70120","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":611.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MASTOIDS 3/PLUS VIEWS","code_information":[{"code":"Px00032010009","type":"CDM"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR INTERNAL AUDITORY CANAL","code_information":[{"code":"Px00032010010","type":"CDM"},{"code":"70134","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":749.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FACIAL BONES LT/3 VIEWS","code_information":[{"code":"Px00032010011","type":"CDM"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FACIAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010012","type":"CDM"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1344.0,"discounted_cash":940.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR NASAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010014","type":"CDM"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"discounted_cash":536.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TEAR DUCT","code_information":[{"code":"Px00032010015","type":"CDM"},{"code":"70170","type":"HCPCS"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1472.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":305.0,"discounted_cash":213.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR OPTIC FORAMINA","code_information":[{"code":"Px00032010016","type":"CDM"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ORBITS MIN 4 VIEWS","code_information":[{"code":"Px00032010017","type":"CDM"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.0,"discounted_cash":874.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SINUSES PARANASAL LT/3 VIEWS","code_information":[{"code":"Px00032010018","type":"CDM"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SINUSES PARANASAL MIN 3 VIEWS","code_information":[{"code":"Px00032010020","type":"CDM"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SELLA TURCICA","code_information":[{"code":"Px00032010021","type":"CDM"},{"code":"70240","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"Px00032010022","type":"CDM"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":695.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SKULL MIN 4 VIEWS","code_information":[{"code":"Px00032010023","type":"CDM"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.0,"discounted_cash":968.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TEETH 1 VIEW","code_information":[{"code":"Px00032010024","type":"CDM"},{"code":"70300","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":71.0,"discounted_cash":49.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TEETH PARTIAL MOUTH","code_information":[{"code":"Px00032010025","type":"CDM"},{"code":"70310","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":71.0,"discounted_cash":49.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TEETH FULL MOUTH","code_information":[{"code":"Px00032010026","type":"CDM"},{"code":"70320","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":79.0,"discounted_cash":55.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR JAW JOINT","code_information":[{"code":"Px00032010027","type":"CDM"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR JAW TEMPOROMANDIBULAR JOINT BIL","code_information":[{"code":"Px00032010028","type":"CDM"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"discounted_cash":636.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"Px00032010029","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"Px00032010031","type":"CDM"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR & FLUORSCOPY THROAT","code_information":[{"code":"Px00032010032","type":"CDM"},{"code":"70370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1084.0,"discounted_cash":758.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPEECH EVALUATION COMPLEX","code_information":[{"code":"Px00032010033","type":"CDM"},{"code":"70371","type":"HCPCS"}],"standard_charges":[{"gross_charge":2370.0,"discounted_cash":1659.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SALIVARY GLAND FOR CALCULUS","code_information":[{"code":"Px00032010035","type":"CDM"},{"code":"70380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1084.0,"discounted_cash":758.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SALIVARY DUCT SIALOGRAPHY","code_information":[{"code":"Px00032010036","type":"CDM"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1472.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":305.0,"discounted_cash":213.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR BONE LENGTH STUDY","code_information":[{"code":"Px00032010039","type":"CDM"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.0,"discounted_cash":836.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR BONE SURVEY LIMITED","code_information":[{"code":"Px00032010040","type":"CDM"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":731.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ESOPHAGUS W CONTRAST","code_information":[{"code":"Px00032010041","type":"CDM"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.0,"discounted_cash":722.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR RIBS UNI 2 VIEWS","code_information":[{"code":"Px00032010045","type":"CDM"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":548.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR RIBS/CHEST UNI MIN 3 VIEWS","code_information":[{"code":"Px00032010046","type":"CDM"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR RIBS BIL 3 VIEWS","code_information":[{"code":"Px00032010048","type":"CDM"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":637.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR RIBS/CHEST BILAT","code_information":[{"code":"Px00032010049","type":"CDM"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":730.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR STERNUM MIN 2 VIEWS","code_information":[{"code":"Px00032010050","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR STERNOCLAVICULAR JOINTS MIN 3 VIEWS","code_information":[{"code":"Px00032010051","type":"CDM"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE 1 VIEW ANY LEVEL","code_information":[{"code":"Px00032010053","type":"CDM"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010055","type":"CDM"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"Px00032010056","type":"CDM"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":833.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CERVICAL SPINE 6 OR MORE VIEWS","code_information":[{"code":"Px00032010057","type":"CDM"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"Px00032010059","type":"CDM"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"Px00032010060","type":"CDM"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE THORACIC MIN 4 VIEWS","code_information":[{"code":"Px00032010061","type":"CDM"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":616.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE THORACOLUMBAR MIN 2 VIEWS","code_information":[{"code":"Px00032010062","type":"CDM"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":687.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010065","type":"CDM"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPINE LUMBOSACRAL MIN 4 VIEWS","code_information":[{"code":"Px00032010066","type":"CDM"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":917.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1838.0,"discounted_cash":1286.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1139.0,"discounted_cash":797.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR PELVIS 1-2 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010069","type":"CDM"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":515.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":978.0,"discounted_cash":684.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SACROILIAC JOINTS 1-2 VIEWS","code_information":[{"code":"Px00032010073","type":"CDM"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.0,"discounted_cash":529.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SACROILIAC JOINTS 3/PLUS VIEWS","code_information":[{"code":"Px00032010074","type":"CDM"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TAILBONE MIN 2 VIEWS","code_information":[{"code":"Px00032010075","type":"CDM"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MYELOGRAPHY CERVICAL","code_information":[{"code":"Px00032010076","type":"CDM"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1885.0,"discounted_cash":1319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1742.0,"discounted_cash":1219.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MYELOGRAPHY THORACIC","code_information":[{"code":"Px00032010077","type":"CDM"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1286.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1742.0,"discounted_cash":1219.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MYELOGRAPHY LUMBAR","code_information":[{"code":"Px00032010078","type":"CDM"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2042.0,"discounted_cash":1429.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1935.0,"discounted_cash":1354.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MYELOGRAPHY SPINE 2/PLUS REGIONS","code_information":[{"code":"Px00032010079","type":"CDM"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2357.0,"discounted_cash":1649.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1742.0,"discounted_cash":1219.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR DISKOGRAPHY CERVICAL/THORACIC","code_information":[{"code":"Px00032010081","type":"CDM"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":8966.0,"discounted_cash":6276.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR DISKOGRAPHY LUMBAR","code_information":[{"code":"Px00032010083","type":"CDM"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":8966.0,"discounted_cash":6276.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CLAVICLE  COMPLETE","code_information":[{"code":"Px00032010085","type":"CDM"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ELBOW LIMITED","code_information":[{"code":"Px00032010086","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":431.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR HEEL MIN 2 VIEWS","code_information":[{"code":"Px00032010088","type":"CDM"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":473.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"Px00032010089","type":"CDM"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":522.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"Px00032010091","type":"CDM"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SHOULDER 1 VIEW","code_information":[{"code":"Px00032010092","type":"CDM"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":378.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SHOULDER ARTHROGRAPHY","code_information":[{"code":"Px00032010097","type":"CDM"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":732.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":992.0,"discounted_cash":694.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CONTRAST ANKLE","code_information":[{"code":"Px00032010098","type":"CDM"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":528.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":715.0,"discounted_cash":500.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SHOULDER A-C JOINTS BIL","code_information":[{"code":"Px00032010099","type":"CDM"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR JAW PANARAMIC","code_information":[{"code":"Px00032010100","type":"CDM"},{"code":"70355","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":71.0,"discounted_cash":49.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR HUMERUS 1 VIEW","code_information":[{"code":"Px00032010101","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"Px00032010102","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"Px00032010105","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":431.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ELBOW COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010106","type":"CDM"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"Px00032010107","type":"CDM"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"Px00032010110","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":508.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ARTHROGRAM OF ELBOW","code_information":[{"code":"Px00032010111","type":"CDM"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":732.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":992.0,"discounted_cash":694.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ARM INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010115","type":"CDM"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR WRIST 1 VIEW","code_information":[{"code":"Px00032010117","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"Px00032010118","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR WRIST COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010119","type":"CDM"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00032010122","type":"CDM"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":616.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":715.0,"discounted_cash":500.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR HAND 1 VIEW","code_information":[{"code":"Px00032010125","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"Px00032010127","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR HAND MIN 3 VIEWS","code_information":[{"code":"Px00032010129","type":"CDM"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FINGERS(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010131","type":"CDM"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ABDOMEN 3/PLUS VIEWS","code_information":[{"code":"Px00032010135","type":"CDM"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":781.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR HIP ARTHROGRAPHY","code_information":[{"code":"Px00032010140","type":"CDM"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":781.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":992.0,"discounted_cash":694.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR KNEE 1-2 VIEWS","code_information":[{"code":"Px00032010149","type":"CDM"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":480.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"Px00032010152","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":101.0,"discounted_cash":70.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR KNEE 4/PLUS VIEWS","code_information":[{"code":"Px00032010154","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":660.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":106.0,"discounted_cash":74.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR KNEES STANDING BILAT","code_information":[{"code":"Px00032010156","type":"CDM"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR KNEE JOINT W CONTRAST","code_information":[{"code":"Px00032010157","type":"CDM"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.0,"discounted_cash":722.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":715.0,"discounted_cash":500.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR LOWER LEG 2 VIEWS","code_information":[{"code":"Px00032010159","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR LEG INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010161","type":"CDM"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"Px00032010163","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":508.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANKLE COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010165","type":"CDM"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":522.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ABDOMEN COMPLETE SERIES","code_information":[{"code":"Px00032010175","type":"CDM"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1304.0,"discounted_cash":912.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR PERITONEUM","code_information":[{"code":"Px00032010176","type":"CDM"},{"code":"74190","type":"HCPCS"}],"standard_charges":[{"gross_charge":4776.0,"discounted_cash":3343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3089.0,"discounted_cash":2162.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY","code_information":[{"code":"Px00032010179","type":"CDM"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.0,"discounted_cash":1146.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2140.0,"discounted_cash":1498.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SMALL INTESTINE W CONTRAST","code_information":[{"code":"Px00032010187","type":"CDM"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.0,"discounted_cash":1434.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2103.0,"discounted_cash":1472.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ABDOMEN PORTABLE 1 VIEW","code_information":[{"code":"Px00032010190","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR COLON W CONTRAST","code_information":[{"code":"Px00032010191","type":"CDM"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.0,"discounted_cash":1399.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR COLON DOUBLE CONTRAST","code_information":[{"code":"Px00032010192","type":"CDM"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2673.0,"discounted_cash":1871.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR COLON ENEMA AIR/CONTRAST BLOCKAGE","code_information":[{"code":"Px00032010193","type":"CDM"},{"code":"74283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1281.0,"discounted_cash":896.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":442.0,"discounted_cash":309.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CONTRAST GALLBLADDER","code_information":[{"code":"Px00032010194","type":"CDM"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.0,"discounted_cash":877.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":102.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00032010196","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2046.0,"discounted_cash":1432.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR BILE DUCT ENDOSCOPY","code_information":[{"code":"Px00032010201","type":"CDM"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3911.0,"discounted_cash":2737.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR FOR PANCREAS ENDOSCOPY CATH","code_information":[{"code":"Px00032010202","type":"CDM"},{"code":"74329","type":"HCPCS"}],"standard_charges":[{"gross_charge":4608.0,"discounted_cash":3225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR BILE/PANC ENDOSCOPY","code_information":[{"code":"Px00032010203","type":"CDM"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":4550.0,"discounted_cash":3185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR INTRO LONG GI TUBE","code_information":[{"code":"Px00032010204","type":"CDM"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.0,"discounted_cash":1773.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR GUIDE INTESTINAL TUBE","code_information":[{"code":"Px00032010205","type":"CDM"},{"code":"74355","type":"HCPCS"}],"standard_charges":[{"gross_charge":2502.0,"discounted_cash":1751.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR GUIDE GI DILATION","code_information":[{"code":"Px00032010206","type":"CDM"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":1132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR BILE DUCT DILATION W/WO STENT PLCMT","code_information":[{"code":"Px00032010207","type":"CDM"},{"code":"74363","type":"HCPCS"}],"standard_charges":[{"gross_charge":5482.0,"discounted_cash":3837.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2534.0,"discounted_cash":1773.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UROGRAPHY INFUSION","code_information":[{"code":"Px00032010209","type":"CDM"},{"code":"74410","type":"HCPCS"}],"standard_charges":[{"gross_charge":4472.0,"discounted_cash":3130.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UROGRAPHY INFUSION W/TOMOGRAPHY","code_information":[{"code":"Px00032010210","type":"CDM"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":4696.0,"discounted_cash":3287.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":264.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR UROGRAPHY RETROGRADE W/WO KUB W CONTRAST","code_information":[{"code":"Px00032010211","type":"CDM"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1507.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR UROGRAPHY ANTEGRADE W CONTRAST","code_information":[{"code":"Px00032010212","type":"CDM"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1979.0,"discounted_cash":1385.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CYSTOGRAPHY MIN 3 VIEWS W CONTRAST","code_information":[{"code":"Px00032010213","type":"CDM"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1772.0,"discounted_cash":1240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR MALE GENITAL TRACT","code_information":[{"code":"Px00032010214","type":"CDM"},{"code":"74440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":1208.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR PENIS","code_information":[{"code":"Px00032010215","type":"CDM"},{"code":"74445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":1208.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR URETHRA/BLADDER RETRO W CONTRAST","code_information":[{"code":"Px00032010216","type":"CDM"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1903.0,"discounted_cash":1332.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR URETHRA/BLADDER VOIDING","code_information":[{"code":"Px00032010217","type":"CDM"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":2071.0,"discounted_cash":1449.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR KIDNEY LESION","code_information":[{"code":"Px00032010218","type":"CDM"},{"code":"74470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4776.0,"discounted_cash":3343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":689.0,"discounted_cash":482.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DILATION URETERS/URETHRA RS&I","code_information":[{"code":"Px00032010221","type":"CDM"},{"code":"74485","type":"HCPCS"}],"standard_charges":[{"gross_charge":7942.0,"discounted_cash":5559.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1144.0,"discounted_cash":800.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR UTERUS & FALLOPIAN TUBE W CONTRAST","code_information":[{"code":"Px00032010223","type":"CDM"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1472.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":305.0,"discounted_cash":213.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FALLOPIAN TUBE CATH","code_information":[{"code":"Px00032010224","type":"CDM"},{"code":"74742","type":"HCPCS"}],"standard_charges":[{"gross_charge":3107.0,"discounted_cash":2174.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR PERINEUM","code_information":[{"code":"Px00032010225","type":"CDM"},{"code":"74775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":1208.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AORTOGRAPHY THORACIC W/O SERIAL","code_information":[{"code":"Px00032010226","type":"CDM"},{"code":"75600","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR AORTOGRAPHY THORACIC SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010227","type":"CDM"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":4928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR AORTOGRAPHY ABDOMEN SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010228","type":"CDM"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO SPINE SELECTIVE W CONTRAST","code_information":[{"code":"Px00032010239","type":"CDM"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":12341.0,"discounted_cash":8638.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11690.0,"discounted_cash":8183.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO EXTREMITY UNILATERAL W CONTRAST","code_information":[{"code":"Px00032010240","type":"CDM"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIOGRAPHY EXTREMITY BILATERAL RS&I","code_information":[{"code":"Px00032010241","type":"CDM"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO ABDOMEN VISCERAL W CONTRAST","code_information":[{"code":"Px00032010244","type":"CDM"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":12341.0,"discounted_cash":8638.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11690.0,"discounted_cash":8183.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I","code_information":[{"code":"Px00032010245","type":"CDM"},{"code":"75731","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ARTERY ADRENALS BILAT","code_information":[{"code":"Px00032010246","type":"CDM"},{"code":"75733","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO PELVIC W CONTRAST","code_information":[{"code":"Px00032010247","type":"CDM"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO PULMONARY W CONTRAST UNI","code_information":[{"code":"Px00032010248","type":"CDM"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO PULMONARY W CONTRAST BIL","code_information":[{"code":"Px00032010249","type":"CDM"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ARTERY LUNG NON-SELECTIVE","code_information":[{"code":"Px00032010250","type":"CDM"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":2364.0,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO MAMMARY INTERNAL","code_information":[{"code":"Px00032010251","type":"CDM"},{"code":"75756","type":"HCPCS"}],"standard_charges":[{"gross_charge":3347.0,"discounted_cash":2342.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANGIO EA ADDITIONAL VESSEL","code_information":[{"code":"Px00032010252","type":"CDM"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":5055.0,"discounted_cash":3538.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR LYMPH VESSEL ARM/LEG","code_information":[{"code":"Px00032010254","type":"CDM"},{"code":"75801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":766.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":905.0,"discounted_cash":633.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR LYMPH VESSEL ARMS/LEGS BILAT","code_information":[{"code":"Px00032010255","type":"CDM"},{"code":"75803","type":"HCPCS"}],"standard_charges":[{"gross_charge":2168.0,"discounted_cash":1517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2054.0,"discounted_cash":1437.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR LYMPH VESSEL TRUNK","code_information":[{"code":"Px00032010256","type":"CDM"},{"code":"75805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2168.0,"discounted_cash":1517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2054.0,"discounted_cash":1437.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR LYMPH VESSEL TRUNK BILAT","code_information":[{"code":"Px00032010257","type":"CDM"},{"code":"75807","type":"HCPCS"}],"standard_charges":[{"gross_charge":2168.0,"discounted_cash":1517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2054.0,"discounted_cash":1437.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR NONVASCULAR SHUNT","code_information":[{"code":"Px00032010258","type":"CDM"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":1126.0,"discounted_cash":788.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN SPLEEN/LIVER","code_information":[{"code":"Px00032010259","type":"CDM"},{"code":"75810","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEINS EXTREMITY UNI W CONTRAST","code_information":[{"code":"Px00032010260","type":"CDM"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":2196.0,"discounted_cash":1537.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEINS EXTREMITY BIL W CONTRAST","code_information":[{"code":"Px00032010261","type":"CDM"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2976.0,"discounted_cash":2083.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2976.0,"discounted_cash":2083.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEINS CAVAL INFERIOR W CONTRAST","code_information":[{"code":"Px00032010262","type":"CDM"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEINS CAVAL SUPERIOR W CONTRAST","code_information":[{"code":"Px00032010263","type":"CDM"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":3447.0,"discounted_cash":2412.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN KIDNEY UNI W CONTRAST","code_information":[{"code":"Px00032010264","type":"CDM"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN KIDNEYS BILAT","code_information":[{"code":"Px00032010265","type":"CDM"},{"code":"75833","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN ADRENAL GLAND","code_information":[{"code":"Px00032010266","type":"CDM"},{"code":"75840","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN ADRENAL GLANDS BILAT","code_information":[{"code":"Px00032010267","type":"CDM"},{"code":"75842","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEINS VENOUS SINUS W CONTRAST","code_information":[{"code":"Px00032010268","type":"CDM"},{"code":"75860","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1776.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEINS SUP SAGGITAL SINUS W CONTRAST","code_information":[{"code":"Px00032010269","type":"CDM"},{"code":"75870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2364.0,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":905.0,"discounted_cash":633.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN EPIDURAL","code_information":[{"code":"Px00032010270","type":"CDM"},{"code":"75872","type":"HCPCS"}],"standard_charges":[{"gross_charge":2196.0,"discounted_cash":1537.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN EYE SOCKET","code_information":[{"code":"Px00032010279","type":"CDM"},{"code":"75880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2196.0,"discounted_cash":1537.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR PRQ TRANSHEPATIC PORTOGRAM W HEMO EVAL","code_information":[{"code":"Px00032010280","type":"CDM"},{"code":"75885","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN W/O HEMODYN EVAL","code_information":[{"code":"Px00032010281","type":"CDM"},{"code":"75887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":2660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN HEPATIC W/ HEMODYN EVAL","code_information":[{"code":"Px00032010282","type":"CDM"},{"code":"75889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VEIN HEPATIC W/O HEMODYN EVAL","code_information":[{"code":"Px00032010283","type":"CDM"},{"code":"75891","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR VENOUS SAMPLING W/WO ANGIO","code_information":[{"code":"Px00032010284","type":"CDM"},{"code":"75893","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":4635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TRANSCATH EMBOLIZ THERAPY W CONTRAST","code_information":[{"code":"Px00032010285","type":"CDM"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":19131.0,"discounted_cash":13391.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3536.0,"discounted_cash":2475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE CVA DEVICE OBSTRUCT","code_information":[{"code":"Px00032010289","type":"CDM"},{"code":"75901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVE CVA LUMEN OBSTRUCT","code_information":[{"code":"Px00032010290","type":"CDM"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":2037.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR ENDOVASC THOR AORTA REPAIR","code_information":[{"code":"Px00032010297","type":"CDM"},{"code":"75956","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR ENDOVASC THOR AORTA REPAIR SUBCLAV","code_information":[{"code":"Px00032010298","type":"CDM"},{"code":"75957","type":"HCPCS"}],"standard_charges":[{"gross_charge":5473.0,"discounted_cash":3831.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VASCULAR BIOPSY TRANSCATHETER","code_information":[{"code":"Px00032010307","type":"CDM"},{"code":"75970","type":"HCPCS"}],"standard_charges":[{"gross_charge":7030.0,"discounted_cash":4921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR CHANGE TUBE/CATH W CONTRAST","code_information":[{"code":"Px00032010311","type":"CDM"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":2991.0,"discounted_cash":2093.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3567.0,"discounted_cash":2496.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"Px00032010318","type":"CDM"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR PEDIATRIC FOREIGN BODY 1 VIEW","code_information":[{"code":"Px00032010320","type":"CDM"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1393.0,"discounted_cash":975.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":59.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FISTULA/SINUS ABSCESS","code_information":[{"code":"Px00032010321","type":"CDM"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1472.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":305.0,"discounted_cash":213.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"Px00032010322","type":"CDM"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1513.0,"discounted_cash":1059.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TOMOGRAPHY SINGLE PLANE","code_information":[{"code":"Px00032010323","type":"CDM"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.0,"discounted_cash":1208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CINE/VIDEO","code_information":[{"code":"Px00032010326","type":"CDM"},{"code":"76120","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":685.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":141.0,"discounted_cash":98.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CONSULT PERFORMED AT DIFFERENT SITE","code_information":[{"code":"Px00032010327","type":"CDM"},{"code":"76140","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UNLISTED FLUOROSCOPIC PROCEDURE","code_information":[{"code":"Px00032010328","type":"CDM"},{"code":"76496","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","code_information":[{"code":"Px00032010330","type":"CDM"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.0,"discounted_cash":982.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FL GUIDE PLCMT NEEDLE ADD ON","code_information":[{"code":"Px00032010331","type":"CDM"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLUOROGUIDE FOR SPINE INJECT","code_information":[{"code":"Px00032010332","type":"CDM"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.0,"discounted_cash":570.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"Px00032010338","type":"CDM"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR BONE SURVEY COMPLETE","code_information":[{"code":"Px00032010341","type":"CDM"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1441.0,"discounted_cash":1008.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR BONE SURVEY INFANT","code_information":[{"code":"Px00032010342","type":"CDM"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":786.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR JOINT SURVEY 1 VIEW","code_information":[{"code":"Px00032010343","type":"CDM"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.0,"discounted_cash":671.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY CDM","code_information":[{"code":"Px00032010351","type":"CDM"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":1722.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010352","type":"CDM"},{"code":"74221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RADIOLOGY UNLISTED PROCEDURE","code_information":[{"code":"Px00032010465","type":"CDM"},{"code":"76499","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":169.0,"discounted_cash":118.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR SHOULDER COMPLETE MIN 2 VIEWS","code_information":[{"code":"Px00032010481","type":"CDM"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":505.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERQ STENT/CHEST VERT ART","code_information":[{"code":"Px00032010495","type":"CDM"},{"code":"0075T","type":"HCPCS"}],"standard_charges":[{"gross_charge":19262.0,"discounted_cash":13483.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC S&I STENT/CHEST VERT ART","code_information":[{"code":"Px00032010496","type":"CDM"},{"code":"0076T","type":"HCPCS"}],"standard_charges":[{"gross_charge":4818.0,"discounted_cash":3372.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR LOWER LEG LIMITED","code_information":[{"code":"Px00032010499","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ANKLE 1 VIEW","code_information":[{"code":"Px00032010503","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":508.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FOOT 1 VIEW","code_information":[{"code":"Px00032010505","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":508.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR STERNUM 1 VIEW","code_information":[{"code":"Px00032010600","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR CINE/VIDEO ADD ON","code_information":[{"code":"Px00032010601","type":"CDM"},{"code":"76125","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":601.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 1 VIEW","code_information":[{"code":"Px00032010604","type":"CDM"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":465.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ENTIRE SPINE 2 OR 3 VIEWS","code_information":[{"code":"Px00032010605","type":"CDM"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":710.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ENTIRE SPINE 4 OR 5 VIEWS","code_information":[{"code":"Px00032010606","type":"CDM"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":1021.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR ENTIRE SPINE MIN 6 VIEWS","code_information":[{"code":"Px00032010607","type":"CDM"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1950.0,"discounted_cash":1365.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":83.0,"discounted_cash":58.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":816.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":974.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1071.0,"discounted_cash":749.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1144.0,"discounted_cash":800.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1218.0,"discounted_cash":852.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":149.0,"discounted_cash":104.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FEMUR 1 VIEW","code_information":[{"code":"Px00032010614","type":"CDM"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR FEMUR MIN 2 VIEWS","code_information":[{"code":"Px00032010615","type":"CDM"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":648.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":96.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR TMJ ARTHROGRAM","code_information":[{"code":"Px00032210001","type":"CDM"},{"code":"70332","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.0,"discounted_cash":1117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":556.0,"discounted_cash":389.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"Px00032410014","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":115.0,"discounted_cash":80.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"Px00032410015","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":115.0,"discounted_cash":80.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CHEST 3 VIEWS","code_information":[{"code":"Px00032410016","type":"CDM"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":115.0,"discounted_cash":80.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CHEST 4/PLUS VIEWS","code_information":[{"code":"Px00032410017","type":"CDM"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":862.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":286.0,"discounted_cash":200.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC XR CHEST PORTABLE 1 VIEW","code_information":[{"code":"Px00032410018","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":115.0,"discounted_cash":80.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHEMO SQ OR IM NON HORMONAL CDM","code_information":[{"code":"Px00033110001","type":"CDM"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":548.0,"discounted_cash":383.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO CDM","code_information":[{"code":"Px00033110002","type":"CDM"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHEMO INJECTION VIA SUBQ RESERVOIR CDM","code_information":[{"code":"Px00033110006","type":"CDM"},{"code":"96542","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":630.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":931.0,"discounted_cash":651.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":885.0,"discounted_cash":619.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THER RAD SIMULATION SIMPLE","code_information":[{"code":"Px00033310006","type":"CDM"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":279.0,"discounted_cash":195.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THER RAD SIMULATION INTERMEDIATE","code_information":[{"code":"Px00033310007","type":"CDM"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":755.0,"discounted_cash":528.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THER RAD SIMULATION COMPLEX","code_information":[{"code":"Px00033310008","type":"CDM"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.0,"discounted_cash":791.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":755.0,"discounted_cash":528.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THER RAD SIMULATION 3D","code_information":[{"code":"Px00033310009","type":"CDM"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":7457.0,"discounted_cash":5219.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BASIC DOSIMETRY CALC","code_information":[{"code":"Px00033310010","type":"CDM"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RADIOTHERAPY DOSE PLAN, IMRT","code_information":[{"code":"Px00033310012","type":"CDM"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":4302.0,"discounted_cash":3011.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2493.0,"discounted_cash":1745.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL TELETX PORT PLAN","code_information":[{"code":"Px00033310018","type":"CDM"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.0,"discounted_cash":1030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":755.0,"discounted_cash":528.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL RADIATION DOSIMETRY","code_information":[{"code":"Px00033310022","type":"CDM"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":279.0,"discounted_cash":195.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TREATMENT DEVICES SIMPLE","code_information":[{"code":"Px00033310023","type":"CDM"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":518.0,"discounted_cash":362.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TREATMENT DEVICES INTERMEDIATE","code_information":[{"code":"Px00033310024","type":"CDM"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":475.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":518.0,"discounted_cash":362.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TREATMENT DEVICES COMPLEX","code_information":[{"code":"Px00033310025","type":"CDM"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1601.0,"discounted_cash":1120.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONTINUING PHYSICS CONSULT","code_information":[{"code":"Px00033310027","type":"CDM"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":416.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":279.0,"discounted_cash":195.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DESIGN MLC DEVICE FOR IMRT","code_information":[{"code":"Px00033310028","type":"CDM"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":12162.0,"discounted_cash":8513.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":755.0,"discounted_cash":528.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPECIAL PHYSICS CONSULT","code_information":[{"code":"Px00033310029","type":"CDM"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT","code_information":[{"code":"Px00033310030","type":"CDM"},{"code":"77371","type":"HCPCS"}],"standard_charges":[{"gross_charge":77740.0,"discounted_cash":54418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14121.0,"discounted_cash":9884.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8693.0,"discounted_cash":6085.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SBRT DELIVERY","code_information":[{"code":"Px00033310035","type":"CDM"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":3822.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4651.0,"discounted_cash":3255.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PORT VERIF FILMS PER 5 FRACTNS","code_information":[{"code":"Px00033310051","type":"CDM"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPECIAL RADIATION TREATMENT","code_information":[{"code":"Px00033310057","type":"CDM"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":781.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC APPLY INTRCAV RADIAT SIMPLE","code_information":[{"code":"Px00033310059","type":"CDM"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":5883.0,"discounted_cash":4118.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":871.0,"discounted_cash":609.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC APPLY INTRCAV RADIAT INTERM","code_information":[{"code":"Px00033310060","type":"CDM"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":6195.0,"discounted_cash":4336.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":871.0,"discounted_cash":609.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC APPLY INTRCAV RADIAT COMPL","code_information":[{"code":"Px00033310061","type":"CDM"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":6702.0,"discounted_cash":4691.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":871.0,"discounted_cash":609.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC APPLY INTERSTITIAL RAD SRC COMPLX","code_information":[{"code":"Px00033310064","type":"CDM"},{"code":"77778","type":"HCPCS"}],"standard_charges":[{"gross_charge":7742.0,"discounted_cash":5419.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2217.0,"discounted_cash":1551.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RADIATION HANDLING","code_information":[{"code":"Px00033310074","type":"CDM"},{"code":"77790","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT UTERI TANDEMS/OVOIDS","code_information":[{"code":"Px00033310082","type":"CDM"},{"code":"57155","type":"HCPCS"}],"standard_charges":[{"gross_charge":3318.0,"discounted_cash":2322.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3318.0,"discounted_cash":2322.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT VAGINAL BRACHYTX DEVICE","code_information":[{"code":"Px00033310083","type":"CDM"},{"code":"57156","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":420.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":511.0,"discounted_cash":357.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT INTERSTITIAL MARKERS ABDOMINAL/PELVIC FOR RAD THERAPY","code_information":[{"code":"Px00033310085","type":"CDM"},{"code":"49411","type":"HCPCS"}],"standard_charges":[{"gross_charge":5562.0,"discounted_cash":3893.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5285.0,"discounted_cash":3699.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TELETHX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310091","type":"CDM"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TELETHX ISODOSE PLAN COMPLEX","code_information":[{"code":"Px00033310092","type":"CDM"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310093","type":"CDM"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE INTERMEDIATE","code_information":[{"code":"Px00033310094","type":"CDM"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":601.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE COMPLEX","code_information":[{"code":"Px00033310095","type":"CDM"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":601.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMRT DELIVERY SIMPLE","code_information":[{"code":"Px00033310096","type":"CDM"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMRT DELIVERY COMPLEX","code_information":[{"code":"Px00033310097","type":"CDM"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RAD TX SIMPLE","code_information":[{"code":"Px00033310099","type":"CDM"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RAD TX INTERMEDIATE","code_information":[{"code":"Px00033310100","type":"CDM"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RAD TX COMPLEX","code_information":[{"code":"Px00033310101","type":"CDM"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":394.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2643.0,"discounted_cash":1850.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3636.0,"discounted_cash":2545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3850.0,"discounted_cash":2695.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":209.0,"discounted_cash":146.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHEMO IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00033510003","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1622.0,"discounted_cash":1135.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1541.0,"discounted_cash":1078.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHEMO IV INFUSION ADDL HR CDM","code_information":[{"code":"Px00033510004","type":"CDM"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":229.0,"discounted_cash":160.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1624.0,"discounted_cash":1136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMO ADMIN IA PUSH CDM","code_information":[{"code":"Px00033510008","type":"CDM"},{"code":"96420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.0,"discounted_cash":1099.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1691.0,"discounted_cash":1183.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":885.0,"discounted_cash":619.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1622.0,"discounted_cash":1135.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1541.0,"discounted_cash":1078.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TYSABRI INFUSION FIRST HR","code_information":[{"code":"Px00033510017","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1622.0,"discounted_cash":1135.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TYSABRI INFUSION EACH ADDL HR","code_information":[{"code":"Px00033510018","type":"CDM"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NM BONE MARROW LTD","code_information":[{"code":"Px00034010002","type":"CDM"},{"code":"78102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2140.0,"discounted_cash":1498.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11177.0,"discounted_cash":7823.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NM PULM PERFUSION DIFF","code_information":[{"code":"Px00034010009","type":"CDM"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":580.0,"discounted_cash":406.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM HEPATOBILIARY SYSTEM","code_information":[{"code":"Px00034010010","type":"CDM"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":3264.0,"discounted_cash":2284.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":706.0,"discounted_cash":494.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROID MET IMAGING LIMITED","code_information":[{"code":"Px00034110006","type":"CDM"},{"code":"78015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3356.0,"discounted_cash":2349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROID MET IMAGING WHOLE BODY","code_information":[{"code":"Px00034110007","type":"CDM"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":5403.0,"discounted_cash":3782.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM THYROID CA METS UPTAKE","code_information":[{"code":"Px00034110008","type":"CDM"},{"code":"78020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1833.0,"discounted_cash":1283.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NM PARATHYROID","code_information":[{"code":"Px00034110009","type":"CDM"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":4799.0,"discounted_cash":3359.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":545.0,"discounted_cash":381.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ADRENAL IMAGING","code_information":[{"code":"Px00034110010","type":"CDM"},{"code":"78075","type":"HCPCS"}],"standard_charges":[{"gross_charge":10138.0,"discounted_cash":7096.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2188.0,"discounted_cash":1531.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED PROCEDURE ENDOCRINE","code_information":[{"code":"Px00034110011","type":"CDM"},{"code":"78099","type":"HCPCS"}],"standard_charges":[{"gross_charge":3084.0,"discounted_cash":2158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":353.0,"discounted_cash":247.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BONE MARROW IMAGING MULTIPLE","code_information":[{"code":"Px00034110012","type":"CDM"},{"code":"78103","type":"HCPCS"}],"standard_charges":[{"gross_charge":3034.0,"discounted_cash":2123.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":658.0,"discounted_cash":460.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BONE MARROW IMAGING WHOLE BODY","code_information":[{"code":"Px00034110013","type":"CDM"},{"code":"78104","type":"HCPCS"}],"standard_charges":[{"gross_charge":5725.0,"discounted_cash":4007.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":658.0,"discounted_cash":460.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM WHOLE BLOOD VOLUME","code_information":[{"code":"Px00034110016","type":"CDM"},{"code":"78122","type":"HCPCS"}],"standard_charges":[{"gross_charge":4955.0,"discounted_cash":3468.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1072.0,"discounted_cash":750.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPLEEN IMAGING","code_information":[{"code":"Px00034110020","type":"CDM"},{"code":"78185","type":"HCPCS"}],"standard_charges":[{"gross_charge":3397.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NM LYMPH SYSTEM","code_information":[{"code":"Px00034110021","type":"CDM"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":8869.0,"discounted_cash":6208.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":658.0,"discounted_cash":460.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIVER IMAGING STATIC","code_information":[{"code":"Px00034110023","type":"CDM"},{"code":"78201","type":"HCPCS"}],"standard_charges":[{"gross_charge":11130.0,"discounted_cash":7791.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NM LIVER SPLEEN STATIC ONLY","code_information":[{"code":"Px00034110027","type":"CDM"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":4610.0,"discounted_cash":3227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":706.0,"discounted_cash":494.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIVER & SPLEEN IMAGE W/ VASCULAR FLOW","code_information":[{"code":"Px00034110028","type":"CDM"},{"code":"78216","type":"HCPCS"}],"standard_charges":[{"gross_charge":4685.0,"discounted_cash":3279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":706.0,"discounted_cash":494.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110030","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":5993.0,"discounted_cash":4195.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":706.0,"discounted_cash":494.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SERIAL SALIVARY IMAGING","code_information":[{"code":"Px00034110033","type":"CDM"},{"code":"78231","type":"HCPCS"}],"standard_charges":[{"gross_charge":2838.0,"discounted_cash":1986.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM GASTROESOPHAGEAL REFLUX STUDY","code_information":[{"code":"Px00034110036","type":"CDM"},{"code":"78262","type":"HCPCS"}],"standard_charges":[{"gross_charge":4089.0,"discounted_cash":2862.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM GASTRIC EMPTYING IMG STDY","code_information":[{"code":"Px00034110037","type":"CDM"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":5651.0,"discounted_cash":3955.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BREATH TST ATTAIN/ANALYSIS C-14","code_information":[{"code":"Px00034110038","type":"CDM"},{"code":"78267","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":945.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":23.0,"discounted_cash":16.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KIDNEY IMAGING MORPHOLOGY","code_information":[{"code":"Px00034110041","type":"CDM"},{"code":"78700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3386.0,"discounted_cash":2370.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NM ACUTE GI BLEED STUDY","code_information":[{"code":"Px00034110042","type":"CDM"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":5720.0,"discounted_cash":4004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM INTESTINE MECKEL VOLVULUS","code_information":[{"code":"Px00034110044","type":"CDM"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":3938.0,"discounted_cash":2756.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM PERITONEAL VENOUS SHUNT PATENCY","code_information":[{"code":"Px00034110045","type":"CDM"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3978.0,"discounted_cash":2784.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE","code_information":[{"code":"Px00034110046","type":"CDM"},{"code":"78299","type":"HCPCS"}],"standard_charges":[{"gross_charge":2838.0,"discounted_cash":1986.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2838.0,"discounted_cash":1986.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2981.0,"discounted_cash":2086.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":645.0,"discounted_cash":451.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3129.0,"discounted_cash":2190.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":678.0,"discounted_cash":474.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3283.0,"discounted_cash":2298.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":714.0,"discounted_cash":499.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MUSCULOSKELETAL EXAM UNLISTED","code_information":[{"code":"Px00034110052","type":"CDM"},{"code":"78399","type":"HCPCS"}],"standard_charges":[{"gross_charge":13716.0,"discounted_cash":9601.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM CARDIAC SHUNT","code_information":[{"code":"Px00034110053","type":"CDM"},{"code":"78428","type":"HCPCS"}],"standard_charges":[{"gross_charge":5016.0,"discounted_cash":3511.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VASCULAR FLOW IMAGING","code_information":[{"code":"Px00034110054","type":"CDM"},{"code":"78445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.0,"discounted_cash":1904.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":588.0,"discounted_cash":411.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM MYCARD PERFUS SPECT SINGLE","code_information":[{"code":"Px00034110055","type":"CDM"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":10106.0,"discounted_cash":7074.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2183.0,"discounted_cash":1528.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM MYCARD PERFUS SPECT MULTIPLE","code_information":[{"code":"Px00034110056","type":"CDM"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":10106.0,"discounted_cash":7074.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2183.0,"discounted_cash":1528.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYOCARDIAL IMAGE PLANAR SINGLE","code_information":[{"code":"Px00034110057","type":"CDM"},{"code":"78453","type":"HCPCS"}],"standard_charges":[{"gross_charge":10106.0,"discounted_cash":7074.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2183.0,"discounted_cash":1528.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MYOCARDIAL IMAGE PLANAR MULTIPLE","code_information":[{"code":"Px00034110058","type":"CDM"},{"code":"78454","type":"HCPCS"}],"standard_charges":[{"gross_charge":10106.0,"discounted_cash":7074.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2183.0,"discounted_cash":1528.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM CARDIAC BLOOD POOL SINGLE","code_information":[{"code":"Px00034110064","type":"CDM"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":7510.0,"discounted_cash":5257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEART FIRST PASS SINGLE","code_information":[{"code":"Px00034110066","type":"CDM"},{"code":"78481","type":"HCPCS"}],"standard_charges":[{"gross_charge":5186.0,"discounted_cash":3630.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEART IMAGE BLOOD POOL GATED SPECT","code_information":[{"code":"Px00034110068","type":"CDM"},{"code":"78494","type":"HCPCS"}],"standard_charges":[{"gross_charge":8482.0,"discounted_cash":5937.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOVASCULAR EXAM UNLISTED","code_information":[{"code":"Px00034110069","type":"CDM"},{"code":"78499","type":"HCPCS"}],"standard_charges":[{"gross_charge":6791.0,"discounted_cash":4753.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM PULM PERFUSION PARTICULATE","code_information":[{"code":"Px00034110070","type":"CDM"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":5183.0,"discounted_cash":3628.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":580.0,"discounted_cash":406.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PULMONARY VENTILATION IMAGING","code_information":[{"code":"Px00034110072","type":"CDM"},{"code":"78579","type":"HCPCS"}],"standard_charges":[{"gross_charge":3841.0,"discounted_cash":2688.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":580.0,"discounted_cash":406.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM PULM PERFUSION VENT IMAGING","code_information":[{"code":"Px00034110073","type":"CDM"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":7676.0,"discounted_cash":5373.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":814.0,"discounted_cash":569.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM PULM PERFUSION VENT DIFF","code_information":[{"code":"Px00034110077","type":"CDM"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":8673.0,"discounted_cash":6071.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":814.0,"discounted_cash":569.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE","code_information":[{"code":"Px00034110078","type":"CDM"},{"code":"78599","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":1874.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":580.0,"discounted_cash":406.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRAIN IMAGE 4/PLUS VIEWS COMPLETE","code_information":[{"code":"Px00034110081","type":"CDM"},{"code":"78605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1331.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5641.0,"discounted_cash":3948.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRAIN VASCULAR FLOW IMAGING ONLY","code_information":[{"code":"Px00034110084","type":"CDM"},{"code":"78610","type":"HCPCS"}],"standard_charges":[{"gross_charge":4672.0,"discounted_cash":3270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM CSF FLOW CISTERNOGRAM","code_information":[{"code":"Px00034110085","type":"CDM"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":8473.0,"discounted_cash":5931.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CSF VENTRICULOGRAPHY","code_information":[{"code":"Px00034110086","type":"CDM"},{"code":"78635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4485.0,"discounted_cash":3139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CSF SHUNT EVALUATION","code_information":[{"code":"Px00034110087","type":"CDM"},{"code":"78645","type":"HCPCS"}],"standard_charges":[{"gross_charge":4672.0,"discounted_cash":3270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM CSF LEAK DETECTECTION","code_information":[{"code":"Px00034110089","type":"CDM"},{"code":"78650","type":"HCPCS"}],"standard_charges":[{"gross_charge":4672.0,"discounted_cash":3270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM KIDNEY W VASCULAR FLOW","code_information":[{"code":"Px00034110092","type":"CDM"},{"code":"78701","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":2486.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3731.0,"discounted_cash":2611.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":791.0,"discounted_cash":553.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM KIDNEY VASC FLOW FUNC W DRUG","code_information":[{"code":"Px00034110094","type":"CDM"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":3917.0,"discounted_cash":2741.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":830.0,"discounted_cash":581.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RENAL FLOW/FUNCT IMAGE MULTIPLE","code_information":[{"code":"Px00034110095","type":"CDM"},{"code":"78709","type":"HCPCS"}],"standard_charges":[{"gross_charge":4115.0,"discounted_cash":2880.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":872.0,"discounted_cash":610.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC KIDNEY FUNCTION STUDY","code_information":[{"code":"Px00034110097","type":"CDM"},{"code":"78725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3235.0,"discounted_cash":2264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":488.0,"discounted_cash":341.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC URINARY BLADDER RESIDUAL STUDY","code_information":[{"code":"Px00034110098","type":"CDM"},{"code":"78730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.0,"discounted_cash":1213.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3654.0,"discounted_cash":2557.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":791.0,"discounted_cash":553.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM TESTES W VASCULAR FLOW","code_information":[{"code":"Px00034110100","type":"CDM"},{"code":"78761","type":"HCPCS"}],"standard_charges":[{"gross_charge":4556.0,"discounted_cash":3189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":791.0,"discounted_cash":553.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE","code_information":[{"code":"Px00034110101","type":"CDM"},{"code":"78799","type":"HCPCS"}],"standard_charges":[{"gross_charge":3654.0,"discounted_cash":2557.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":791.0,"discounted_cash":553.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3727.0,"discounted_cash":2608.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":726.0,"discounted_cash":508.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":8860.0,"discounted_cash":6202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1243.0,"discounted_cash":870.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":11177.0,"discounted_cash":7823.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2407.0,"discounted_cash":1684.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM TUMOR LCLZN WB GTE 2 DAYS","code_information":[{"code":"Px00034110106","type":"CDM"},{"code":"78804","type":"HCPCS"}],"standard_charges":[{"gross_charge":10138.0,"discounted_cash":7096.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2188.0,"discounted_cash":1531.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV INJ DRUG DX STUDY","code_information":[{"code":"Px00034110110","type":"CDM"},{"code":"78808","type":"HCPCS"}],"standard_charges":[{"gross_charge":2259.0,"discounted_cash":1581.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":488.0,"discounted_cash":341.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE","code_information":[{"code":"Px00034110122","type":"CDM"},{"code":"78999","type":"HCPCS"}],"standard_charges":[{"gross_charge":3588.0,"discounted_cash":2511.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":267.0,"discounted_cash":186.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM HEPATOBILIARY IMG WO PHARM","code_information":[{"code":"Px00034110131","type":"CDM"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":3264.0,"discounted_cash":2284.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":706.0,"discounted_cash":494.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110132","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":5993.0,"discounted_cash":4195.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":706.0,"discounted_cash":494.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","code_information":[{"code":"Px00034110142","type":"CDM"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2300.0,"discounted_cash":1610.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THYROID IMAGING WITH VASCULAR FLOW","code_information":[{"code":"Px00034110143","type":"CDM"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":3140.0,"discounted_cash":2198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4054.0,"discounted_cash":2837.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5090.0,"discounted_cash":3563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8026.0,"discounted_cash":5618.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11737.0,"discounted_cash":8215.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG CDM","code_information":[{"code":"Px00034110150","type":"CDM"},{"code":"78831","type":"HCPCS"}],"standard_charges":[{"gross_charge":12327.0,"discounted_cash":8628.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12938.0,"discounted_cash":9056.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING SB TRANSIT","code_information":[{"code":"Px00034130006","type":"CDM"},{"code":"78265","type":"HCPCS"}],"standard_charges":[{"gross_charge":6277.0,"discounted_cash":4393.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9417.0,"discounted_cash":6591.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RADIOPHARM THERAPY, BY ORAL ADMIN","code_information":[{"code":"Px00034210001","type":"CDM"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3631.0,"discounted_cash":2541.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2087.0,"discounted_cash":1460.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV RADIOPHARM ADMIN","code_information":[{"code":"Px00034210002","type":"CDM"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":3035.0,"discounted_cash":2124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1978.0,"discounted_cash":1384.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IV MONOCLONAL AB THERAPY INFUSION","code_information":[{"code":"Px00034210005","type":"CDM"},{"code":"79403","type":"HCPCS"}],"standard_charges":[{"gross_charge":2278.0,"discounted_cash":1594.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":288.0,"discounted_cash":201.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RADPHARM THER INTRA-ART PARTICULT","code_information":[{"code":"Px00034210007","type":"CDM"},{"code":"79445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2999.0,"discounted_cash":2099.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2087.0,"discounted_cash":1460.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RADIOTHERAPY UNLISTED","code_information":[{"code":"Px00034210009","type":"CDM"},{"code":"79999","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AUTO ALYS XST CT VRT FX ASMT B1 DNS DATA PRP I&R CDM","code_information":[{"code":"Px00035000005","type":"CDM"},{"code":"0691T","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COR FFR DERIVED CTA DATA ANALYSIS CDM","code_information":[{"code":"Px00035000007","type":"CDM"},{"code":"75580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.0,"discounted_cash":2021.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1714.0,"discounted_cash":1199.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL WO & W CONTRAST","code_information":[{"code":"Px00035010006","type":"CDM"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2488.0,"discounted_cash":1741.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1190.0,"discounted_cash":833.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT SOFT TISSUE NECK WO CONTRAST","code_information":[{"code":"Px00035010007","type":"CDM"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.0,"discounted_cash":1219.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT SOFT TISSUE NECK W CONTRAST","code_information":[{"code":"Px00035010008","type":"CDM"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2086.0,"discounted_cash":1460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1057.0,"discounted_cash":739.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2189.0,"discounted_cash":1532.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1190.0,"discounted_cash":833.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY NECK W CONTRAST","code_information":[{"code":"Px00035010010","type":"CDM"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":4215.0,"discounted_cash":2950.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1240.0,"discounted_cash":868.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT THORAX WO CONTRAST","code_information":[{"code":"Px00035010011","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.0,"discounted_cash":1434.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":549.0,"discounted_cash":384.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY CHEST","code_information":[{"code":"Px00035010013","type":"CDM"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3835.0,"discounted_cash":2684.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1231.0,"discounted_cash":861.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT LWR EXTREMITY WO & W CONTRAST","code_information":[{"code":"Px00035010018","type":"CDM"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":2104.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1182.0,"discounted_cash":827.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ANGIO LWR EXTR W/O&W/DYE","code_information":[{"code":"Px00035010020","type":"CDM"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1463.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1231.0,"discounted_cash":861.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CTA ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035010023","type":"CDM"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":6389.0,"discounted_cash":4472.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1231.0,"discounted_cash":861.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ABD & PELVIS WO CONTRAST","code_information":[{"code":"Px00035010024","type":"CDM"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.0,"discounted_cash":2584.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1019.0,"discounted_cash":713.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ABDOMEN & PELVIS W  CONTRAST","code_information":[{"code":"Px00035010025","type":"CDM"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":4934.0,"discounted_cash":3453.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1644.0,"discounted_cash":1150.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1730.0,"discounted_cash":1211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CCTA HEART W/3D IMAGE W/ CONTRAST","code_information":[{"code":"Px00035010028","type":"CDM"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":1398.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":935.0,"discounted_cash":654.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CCTA HEART CONGENITAL W/3D IMAGE W/CONTRAST","code_information":[{"code":"Px00035010029","type":"CDM"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":1398.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":935.0,"discounted_cash":654.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1998.0,"discounted_cash":1398.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":935.0,"discounted_cash":654.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CTA AORTA BIL ILIOFEM W & W/O CONTRAST","code_information":[{"code":"Px00035010031","type":"CDM"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2551.0,"discounted_cash":1785.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1231.0,"discounted_cash":861.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 3D RENDER W/O POSTPROCESS","code_information":[{"code":"Px00035010032","type":"CDM"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.0,"discounted_cash":1290.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC 3D RENDERING W/POSTPROCESS","code_information":[{"code":"Px00035010033","type":"CDM"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1357.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1255.0,"discounted_cash":878.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":337.0,"discounted_cash":235.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT CARDIAC CALCIUM RESEARCH","code_information":[{"code":"Px00035010035","type":"CDM"},{"code":"76497","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":506.0,"discounted_cash":354.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT GUIDE STEREOTACTIC LOCALIZATION","code_information":[{"code":"Px00035010036","type":"CDM"},{"code":"77011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1956.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT GUIDE PLCMT NEEDLE","code_information":[{"code":"Px00035010037","type":"CDM"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2364.0,"discounted_cash":1654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT GUIDE FOR TISSUE ABLATION","code_information":[{"code":"Px00035010038","type":"CDM"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT GUIDE PLCMT RAD FIELD","code_information":[{"code":"Px00035010039","type":"CDM"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT COLONOGRAPHY DX","code_information":[{"code":"Px00035010063","type":"CDM"},{"code":"74261","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CTA ABDOMEN PELVIS","code_information":[{"code":"Px00035010072","type":"CDM"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":10102.0,"discounted_cash":7071.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1644.0,"discounted_cash":1150.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PREVIEW TX PLANNING SOFTWARE","code_information":[{"code":"Px00035010108","type":"CDM"},{"code":"G0288","type":"HCPCS"}],"standard_charges":[{"gross_charge":2208.0,"discounted_cash":1545.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CTA HEAD&NECK W/NONCONTRAST IMG&POST-PXESSING CDM","code_information":[{"code":"Px00035100001","type":"CDM"},{"code":"70471","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.0,"discounted_cash":2566.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT PERFUSION W/CONTRAST CBF","code_information":[{"code":"Px00035110001","type":"CDM"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.0,"discounted_cash":2566.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN WO CONTRAST","code_information":[{"code":"Px00035110002","type":"CDM"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":1151.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT HEAD/BRAIN W CONTRAST","code_information":[{"code":"Px00035110007","type":"CDM"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":1923.0,"discounted_cash":1346.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1057.0,"discounted_cash":739.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT HEAD/BRAIN W & W/O CONTRAST","code_information":[{"code":"Px00035110012","type":"CDM"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.0,"discounted_cash":1686.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1190.0,"discounted_cash":833.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA WO CONTRAST","code_information":[{"code":"Px00035110014","type":"CDM"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2085.0,"discounted_cash":1459.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA W CONTRAST","code_information":[{"code":"Px00035110017","type":"CDM"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1463.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1057.0,"discounted_cash":739.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2532.0,"discounted_cash":1772.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1190.0,"discounted_cash":833.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL WO CONTRAST","code_information":[{"code":"Px00035110022","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1714.0,"discounted_cash":1199.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL W CONTRAST","code_information":[{"code":"Px00035110030","type":"CDM"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.0,"discounted_cash":1397.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1057.0,"discounted_cash":739.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"Px00035110032","type":"CDM"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":4207.0,"discounted_cash":2944.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1240.0,"discounted_cash":868.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CT THORAX W CONTRAST","code_information":[{"code":"Px00035210003","type":"CDM"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3293.0,"discounted_cash":2305.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT THORAX W & W/O CONTRAST","code_information":[{"code":"Px00035210006","type":"CDM"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3623.0,"discounted_cash":2536.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1182.0,"discounted_cash":827.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT NECK SPINE WO CONTRAST","code_information":[{"code":"Px00035210008","type":"CDM"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.0,"discounted_cash":1497.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT NECK SPINE W/DYE","code_information":[{"code":"Px00035210009","type":"CDM"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":2283.0,"discounted_cash":1598.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1057.0,"discounted_cash":739.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT NECK SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210010","type":"CDM"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":2370.0,"discounted_cash":1659.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1190.0,"discounted_cash":833.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT CHEST SPINE WO CONTRAST","code_information":[{"code":"Px00035210011","type":"CDM"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2278.0,"discounted_cash":1594.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":534.0,"discounted_cash":373.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT CHEST SPINE W CONTRAST","code_information":[{"code":"Px00035210012","type":"CDM"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.0,"discounted_cash":1597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT CHEST SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210013","type":"CDM"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":3192.0,"discounted_cash":2234.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1182.0,"discounted_cash":827.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE WO CONTRAST","code_information":[{"code":"Px00035210014","type":"CDM"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2322.0,"discounted_cash":1625.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":534.0,"discounted_cash":373.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE W CONTRAST","code_information":[{"code":"Px00035210015","type":"CDM"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2415.0,"discounted_cash":1690.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210016","type":"CDM"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.0,"discounted_cash":1775.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1182.0,"discounted_cash":827.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CTA PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210017","type":"CDM"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":3715.0,"discounted_cash":2600.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1231.0,"discounted_cash":861.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"Px00035210018","type":"CDM"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1923.0,"discounted_cash":1346.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":534.0,"discounted_cash":373.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"Px00035210020","type":"CDM"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210024","type":"CDM"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":2756.0,"discounted_cash":1929.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1182.0,"discounted_cash":827.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT UPPER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210029","type":"CDM"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1773.0,"discounted_cash":1241.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":534.0,"discounted_cash":373.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT LOWER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210030","type":"CDM"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1749.0,"discounted_cash":1224.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":534.0,"discounted_cash":373.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT UPPER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210031","type":"CDM"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":1841.0,"discounted_cash":1288.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT UPPR EXTREMITY W & W/O CONTRAST","code_information":[{"code":"Px00035210034","type":"CDM"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.0,"discounted_cash":1494.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1182.0,"discounted_cash":827.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2401.0,"discounted_cash":1680.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1231.0,"discounted_cash":861.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"Px00035210038","type":"CDM"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":534.0,"discounted_cash":373.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT LOWER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210040","type":"CDM"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"Px00035210046","type":"CDM"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2568.0,"discounted_cash":1797.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035210047","type":"CDM"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":2802.0,"discounted_cash":1961.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1182.0,"discounted_cash":827.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CT ABDOMEN & PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210054","type":"CDM"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":5370.0,"discounted_cash":3759.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5426.0,"discounted_cash":3798.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1990.0,"discounted_cash":1393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ROBOTIC SURGICAL SYSTEM CDM","code_information":[{"code":"Px00036000019","type":"CDM"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RT BRONCH LEVEL 1 CDM","code_information":[{"code":"Px00036000021","type":"CDM"}],"standard_charges":[{"gross_charge":4494.0,"discounted_cash":3145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 2 CDM","code_information":[{"code":"Px00036000022","type":"CDM"}],"standard_charges":[{"gross_charge":6614.0,"discounted_cash":4629.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 3 CDM","code_information":[{"code":"Px00036000023","type":"CDM"}],"standard_charges":[{"gross_charge":6892.0,"discounted_cash":4824.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 4 CDM","code_information":[{"code":"Px00036000024","type":"CDM"}],"standard_charges":[{"gross_charge":7971.0,"discounted_cash":5579.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 5 CDM","code_information":[{"code":"Px00036000025","type":"CDM"}],"standard_charges":[{"gross_charge":8569.0,"discounted_cash":5998.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 6 CDM","code_information":[{"code":"Px00036000026","type":"CDM"}],"standard_charges":[{"gross_charge":9160.0,"discounted_cash":6412.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 1","code_information":[{"code":"Px00036010001","type":"CDM"}],"standard_charges":[{"gross_charge":2854.0,"discounted_cash":1997.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 2","code_information":[{"code":"Px00036010002","type":"CDM"}],"standard_charges":[{"gross_charge":5638.0,"discounted_cash":3946.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 3","code_information":[{"code":"Px00036010003","type":"CDM"}],"standard_charges":[{"gross_charge":5916.0,"discounted_cash":4141.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 4","code_information":[{"code":"Px00036010004","type":"CDM"}],"standard_charges":[{"gross_charge":6388.0,"discounted_cash":4471.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 5","code_information":[{"code":"Px00036010005","type":"CDM"}],"standard_charges":[{"gross_charge":6861.0,"discounted_cash":4802.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8035.0,"discounted_cash":5624.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4924.0,"discounted_cash":3446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHANGE URETER STENT PERCUT","code_information":[{"code":"Px00036010061","type":"CDM"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":9625.0,"discounted_cash":6737.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7952.0,"discounted_cash":5566.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE URETER STENT PERCUT","code_information":[{"code":"Px00036010062","type":"CDM"},{"code":"50384","type":"HCPCS"}],"standard_charges":[{"gross_charge":6630.0,"discounted_cash":4641.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHANGE EXT/INT URETER STENT","code_information":[{"code":"Px00036010063","type":"CDM"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":5073.0,"discounted_cash":3551.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4193.0,"discounted_cash":2935.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE RENAL TUBE W/FLUORO","code_information":[{"code":"Px00036010064","type":"CDM"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":2148.0,"discounted_cash":1503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1773.0,"discounted_cash":1241.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENDOVASC TEMPORY VESSEL OCCL","code_information":[{"code":"Px00036010067","type":"CDM"},{"code":"61623","type":"HCPCS"}],"standard_charges":[{"gross_charge":25776.0,"discounted_cash":18043.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":21321.0,"discounted_cash":14924.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJ FORAMEN EPIDURAL C/T","code_information":[{"code":"Px00036010069","type":"CDM"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2909.0,"discounted_cash":2036.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL L/S","code_information":[{"code":"Px00036010071","type":"CDM"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":2083.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1508.0,"discounted_cash":1055.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVOUS SYSTEM SURGERY","code_information":[{"code":"Px00036010076","type":"CDM"},{"code":"36010076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":856.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":670.0,"discounted_cash":469.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BEDSIDE DX BRONCHOSCOPE/BRUSH","code_information":[{"code":"Px00036010078","type":"CDM"},{"code":"31623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2825.0,"discounted_cash":1977.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DX BRONCHOSCOPE/LAVAGE","code_information":[{"code":"Px00036010079","type":"CDM"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2854.0,"discounted_cash":1997.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BEDSIDE BRONCHOSCOPY W/BIOPSY(S)","code_information":[{"code":"Px00036010080","type":"CDM"},{"code":"31625","type":"HCPCS"}],"standard_charges":[{"gross_charge":2973.0,"discounted_cash":2081.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2825.0,"discounted_cash":1977.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRONCHOSCOPY/LUNG BX EACH","code_information":[{"code":"Px00036010081","type":"CDM"},{"code":"31628","type":"HCPCS"}],"standard_charges":[{"gross_charge":8618.0,"discounted_cash":6032.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4216.0,"discounted_cash":2951.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRONCHOSCOPY/NEEDLE BX EACH","code_information":[{"code":"Px00036010082","type":"CDM"},{"code":"31629","type":"HCPCS"}],"standard_charges":[{"gross_charge":8618.0,"discounted_cash":6032.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4216.0,"discounted_cash":2951.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST","code_information":[{"code":"Px00036010090","type":"CDM"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2549.0,"discounted_cash":1784.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2422.0,"discounted_cash":1695.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRONCHOSCOPY RECLEAR AIRWAY","code_information":[{"code":"Px00036010091","type":"CDM"},{"code":"31646","type":"HCPCS"}],"standard_charges":[{"gross_charge":2549.0,"discounted_cash":1784.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2422.0,"discounted_cash":1695.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FECAL TRANSPLANT-COLONOSCOPY","code_information":[{"code":"Px00036010095","type":"CDM"}],"standard_charges":[{"gross_charge":10863.0,"discounted_cash":7604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECT FOR LYMPHATIC X-RAY","code_information":[{"code":"Px00036010101","type":"CDM"},{"code":"38790","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY OF LIVER","code_information":[{"code":"Px00036010104","type":"CDM"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3913.0,"discounted_cash":2739.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3232.0,"discounted_cash":2262.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036010105","type":"CDM"},{"code":"49441","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.0,"discounted_cash":3292.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3888.0,"discounted_cash":2721.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLACE CECOSTOMY TUBE PERC","code_information":[{"code":"Px00036010106","type":"CDM"},{"code":"49442","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"Px00036010107","type":"CDM"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","code_information":[{"code":"Px00036010110","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":2618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":663.0,"discounted_cash":464.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRAINAGE OF BREAST LESION","code_information":[{"code":"Px00036010111","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1707.0,"discounted_cash":1194.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MUSCLE BIOPSY SUPERFICIAL","code_information":[{"code":"Px00036010121","type":"CDM"},{"code":"20200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4753.0,"discounted_cash":3327.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEEP MUSCLE BIOPSY","code_information":[{"code":"Px00036010122","type":"CDM"},{"code":"20205","type":"HCPCS"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4753.0,"discounted_cash":3327.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NEEDLE BX MUSCLE","code_information":[{"code":"Px00036010123","type":"CDM"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.0,"discounted_cash":2369.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2796.0,"discounted_cash":1957.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECT SINUS TRACT FOR X-RAY PROC","code_information":[{"code":"Px00036010128","type":"CDM"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJ TENDON ORIGIN/INSERTION","code_information":[{"code":"Px00036010129","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":842.0,"discounted_cash":589.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1021.0,"discounted_cash":714.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":842.0,"discounted_cash":589.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1027.0,"discounted_cash":718.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":842.0,"discounted_cash":589.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00036010132","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":842.0,"discounted_cash":589.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION FOR SHOULDER X-RAY","code_information":[{"code":"Px00036010133","type":"CDM"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION JAW JOINT X-RAY","code_information":[{"code":"Px00036010134","type":"CDM"},{"code":"21116","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 1ST 30 MINS","code_information":[{"code":"Px00036010146","type":"CDM"}],"standard_charges":[{"gross_charge":5494.0,"discounted_cash":3845.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 1ST 30 MINS","code_information":[{"code":"Px00036010147","type":"CDM"}],"standard_charges":[{"gross_charge":5978.0,"discounted_cash":4184.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 1ST 30 MINS","code_information":[{"code":"Px00036010148","type":"CDM"}],"standard_charges":[{"gross_charge":6785.0,"discounted_cash":4749.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 1ST 30 MINS","code_information":[{"code":"Px00036010149","type":"CDM"}],"standard_charges":[{"gross_charge":7352.0,"discounted_cash":5146.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 1ST 30 MINS","code_information":[{"code":"Px00036010150","type":"CDM"}],"standard_charges":[{"gross_charge":8643.0,"discounted_cash":6050.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 1ST 30 MINS","code_information":[{"code":"Px00036010151","type":"CDM"}],"standard_charges":[{"gross_charge":9330.0,"discounted_cash":6531.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS","code_information":[{"code":"Px00036010152","type":"CDM"}],"standard_charges":[{"gross_charge":9718.0,"discounted_cash":6802.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 1ST 30 MINS","code_information":[{"code":"Px00036010153","type":"CDM"}],"standard_charges":[{"gross_charge":10502.0,"discounted_cash":7351.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STENT PLACEMT RETRO CAROTID","code_information":[{"code":"Px00036010187","type":"CDM"},{"code":"37217","type":"HCPCS"}],"standard_charges":[{"gross_charge":4218.0,"discounted_cash":2952.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":33878.0,"discounted_cash":23714.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":21851.0,"discounted_cash":15295.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":33878.0,"discounted_cash":23714.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22496.0,"discounted_cash":15747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VENOUS","code_information":[{"code":"Px00036010192","type":"CDM"},{"code":"37241","type":"HCPCS"}],"standard_charges":[{"gross_charge":33656.0,"discounted_cash":23559.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ARTERY","code_information":[{"code":"Px00036010193","type":"CDM"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":34293.0,"discounted_cash":24005.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ORGAN","code_information":[{"code":"Px00036010194","type":"CDM"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":34293.0,"discounted_cash":24005.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE BLEED","code_information":[{"code":"Px00036010195","type":"CDM"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":33621.0,"discounted_cash":23534.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT VISCERA","code_information":[{"code":"Px00036010196","type":"CDM"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":4519.0,"discounted_cash":3163.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT PERI/RETRO","code_information":[{"code":"Px00036010197","type":"CDM"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4744.0,"discounted_cash":3320.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2800.0,"discounted_cash":1960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMODENERV MUSC NECK","code_information":[{"code":"Px00036010200","type":"CDM"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":501.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 PER MIN","code_information":[{"code":"Px00036010212","type":"CDM"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 PER MIN","code_information":[{"code":"Px00036010214","type":"CDM"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 PER MIN","code_information":[{"code":"Px00036010216","type":"CDM"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 PER MIN","code_information":[{"code":"Px00036010218","type":"CDM"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 PER MIN","code_information":[{"code":"Px00036010220","type":"CDM"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 PER MIN","code_information":[{"code":"Px00036010222","type":"CDM"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 PER MIN","code_information":[{"code":"Px00036010224","type":"CDM"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 PER MIN","code_information":[{"code":"Px00036010226","type":"CDM"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1332.0,"discounted_cash":932.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMODENERV 1 EXT 1-4 EA ADD EXT","code_information":[{"code":"Px00036010237","type":"CDM"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMODENER 1 EXT 5 OR MORE MUSCLES","code_information":[{"code":"Px00036010238","type":"CDM"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":932.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMODENER 1 EXT EA ADDL 5 OR MORE MUSCLES","code_information":[{"code":"Px00036010239","type":"CDM"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMODENERV TRUNK MUSC 1-5","code_information":[{"code":"Px00036010240","type":"CDM"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMODENERV TRUNK MUSC 6/>","code_information":[{"code":"Px00036010241","type":"CDM"},{"code":"64647","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.0,"discounted_cash":1194.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERC TRNSCTH MTRAL VLVE REPAIR CS APPRCH","code_information":[{"code":"Px00036010245","type":"CDM"},{"code":"0345T","type":"HCPCS"}],"standard_charges":[{"gross_charge":19419.0,"discounted_cash":13593.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NAVIGATIONAL BRONCHOSCOPY","code_information":[{"code":"Px00036010248","type":"CDM"},{"code":"31627","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"discounted_cash":913.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD SCIATIC NRV CONT NFS CATH IMG CDM","code_information":[{"code":"Px00036010257","type":"CDM"},{"code":"64446","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR SALIVARY X-RAY","code_information":[{"code":"Px00036010324","type":"CDM"},{"code":"42550","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY OF SALIVARY GLAND, NEEDLE","code_information":[{"code":"Px00036010331","type":"CDM"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.0,"discounted_cash":2369.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2796.0,"discounted_cash":1957.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ABDOMEN SURGERY PROCEDURE","code_information":[{"code":"Px00036010336","type":"CDM"},{"code":"36010336","type":"HCPCS"}],"standard_charges":[{"gross_charge":7148.0,"discounted_cash":5003.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5913.0,"discounted_cash":4139.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEX CYSTOMETROGRAM","code_information":[{"code":"Px00036010339","type":"CDM"},{"code":"51726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2094.0,"discounted_cash":1465.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1729.0,"discounted_cash":1210.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY OF PROSTATE","code_information":[{"code":"Px00036010343","type":"CDM"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":5336.0,"discounted_cash":3735.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4409.0,"discounted_cash":3086.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLACE RADIATION THEAPY DEVICE/MARKER, PROSTATE","code_information":[{"code":"Px00036010344","type":"CDM"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4739.0,"discounted_cash":3317.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"Px00036010345","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY OF THYROID","code_information":[{"code":"Px00036010349","type":"CDM"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1707.0,"discounted_cash":1194.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 6","code_information":[{"code":"Px00036010371","type":"CDM"}],"standard_charges":[{"gross_charge":7099.0,"discounted_cash":4969.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC BONE MARROW BIOPSY","code_information":[{"code":"Px00036010406","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3823.0,"discounted_cash":2676.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2949.0,"discounted_cash":2064.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX CDM","code_information":[{"code":"Px00036010408","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2422.0,"discounted_cash":1695.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY DIAGNOSTIC","code_information":[{"code":"Px00036010413","type":"CDM"}],"standard_charges":[{"gross_charge":5817.0,"discounted_cash":4071.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5022.0,"discounted_cash":3515.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EUS W/ COLONOSCOPY","code_information":[{"code":"Px00036010441","type":"CDM"}],"standard_charges":[{"gross_charge":4622.0,"discounted_cash":3235.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEEDLE ASPIRATION, ESOPH","code_information":[{"code":"Px00036010468","type":"CDM"}],"standard_charges":[{"gross_charge":6355.0,"discounted_cash":4448.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS","code_information":[{"code":"Px00036010480","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1660.0,"discounted_cash":1162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC YAG LASAR PROCEDURE","code_information":[{"code":"Px00036010493","type":"CDM"}],"standard_charges":[{"gross_charge":6905.0,"discounted_cash":4833.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LASER YAG UNILATERAL SUBSEQ","code_information":[{"code":"Px00036010495","type":"CDM"}],"standard_charges":[{"gross_charge":7045.0,"discounted_cash":4931.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC CDM","code_information":[{"code":"Px00036010901","type":"CDM"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1858.0,"discounted_cash":1300.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":343.0,"discounted_cash":240.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AMNIOCENTESIS THERAPEUTIC FLUID REDUCTION","code_information":[{"code":"Px00036010902","type":"CDM"},{"code":"59001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":770.0,"discounted_cash":539.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SURGERY CLASS 1 EA MIN","code_information":[{"code":"Px00036010905","type":"CDM"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SURGERY CLASS 2 EA MIN","code_information":[{"code":"Px00036010906","type":"CDM"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":120.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SURGERY CLASS 3 EA MIN","code_information":[{"code":"Px00036010907","type":"CDM"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SURGERY CLASS 4 EA MIN","code_information":[{"code":"Px00036010908","type":"CDM"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SURGERY CLASS 5 EA MIN","code_information":[{"code":"Px00036010909","type":"CDM"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5468.0,"discounted_cash":3827.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4524.0,"discounted_cash":3166.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-SECTION","code_information":[{"code":"Px00036010960","type":"CDM"}],"standard_charges":[{"gross_charge":30293.0,"discounted_cash":21205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":963.0,"discounted_cash":674.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":963.0,"discounted_cash":674.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C-SECTION MULTI","code_information":[{"code":"Px00036010966","type":"CDM"}],"standard_charges":[{"gross_charge":36064.0,"discounted_cash":25244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR ELBOW X-RAY","code_information":[{"code":"Px00036011001","type":"CDM"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HIP ARTHROGRAM PROC","code_information":[{"code":"Px00036011002","type":"CDM"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR HIP X-RAY W/ANESTH","code_information":[{"code":"Px00036011003","type":"CDM"},{"code":"27095","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECT SACROILIAC JOINT","code_information":[{"code":"Px00036011005","type":"CDM"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.0,"discounted_cash":914.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVE INT/EXT HEM 1 GROUP","code_information":[{"code":"Px00036011024","type":"CDM"},{"code":"46255","type":"HCPCS"}],"standard_charges":[{"gross_charge":8871.0,"discounted_cash":6209.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAINAGE OF SALIVARY GLAND SIMPLE","code_information":[{"code":"Px00036011057","type":"CDM"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EXPLORE/TREAT FINGER JOINT INTERPHALANGEAL JOINT","code_information":[{"code":"Px00036011089","type":"CDM"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":4975.0,"discounted_cash":3482.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INS ICD GEN ONLY W EXIST 2 LDS","code_information":[{"code":"Px00036012005","type":"CDM"},{"code":"33230","type":"HCPCS"}],"standard_charges":[{"gross_charge":77309.0,"discounted_cash":54116.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":18240.0,"discounted_cash":12768.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INS ICD GEN ONLY W EXIST MULT LDS","code_information":[{"code":"Px00036012006","type":"CDM"},{"code":"33231","type":"HCPCS"}],"standard_charges":[{"gross_charge":115768.0,"discounted_cash":81037.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":18240.0,"discounted_cash":12768.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RMV&RPLC ICD GEN SING LEAD SYST","code_information":[{"code":"Px00036012007","type":"CDM"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":77309.0,"discounted_cash":54116.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":18240.0,"discounted_cash":12768.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RMV&RPLC ICD GEN DUAL LEAD SYST","code_information":[{"code":"Px00036012008","type":"CDM"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":77309.0,"discounted_cash":54116.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":18240.0,"discounted_cash":12768.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RMV&RPLC ICD GEN MULT LEAD SYST","code_information":[{"code":"Px00036012009","type":"CDM"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":81754.0,"discounted_cash":57227.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2789.0,"discounted_cash":1952.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1555.0,"discounted_cash":1088.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036100013","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2789.0,"discounted_cash":1952.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY CDM","code_information":[{"code":"Px00036100014","type":"CDM"},{"code":"49402","type":"HCPCS"}],"standard_charges":[{"gross_charge":11940.0,"discounted_cash":8358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IRRIGATE BLADDER SIMPLE LAVAGE &/INSTILLATION CDM","code_information":[{"code":"Px00036100020","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INS TEMP INDWELLING BLADDER CATH SIMPLE / FOLEY CDM","code_information":[{"code":"Px00036100022","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":301.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE CDM","code_information":[{"code":"Px00036100030","type":"CDM"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM","code_information":[{"code":"Px00036100038","type":"CDM"},{"code":"67028","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.0,"discounted_cash":833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABLTJ PERC CRYOABLTJ IMG GDN LXTR/PERPH NERVE CDM","code_information":[{"code":"Px00036100043","type":"CDM"},{"code":"0441T","type":"HCPCS"}],"standard_charges":[{"gross_charge":7271.0,"discounted_cash":5089.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABLTJ PERC CRYOABLTJ IMG GDN NRV PLEX/TRNCL NRV CDM","code_information":[{"code":"Px00036100044","type":"CDM"},{"code":"0442T","type":"HCPCS"}],"standard_charges":[{"gross_charge":24865.0,"discounted_cash":17405.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT CDM","code_information":[{"code":"Px00036100049","type":"CDM"},{"code":"33340","type":"HCPCS"}],"standard_charges":[{"gross_charge":23094.0,"discounted_cash":16165.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SUBDURAL TAP FONTANELLE/SUTUR INFANT INITIAL CDM","code_information":[{"code":"Px00036100062","type":"CDM"},{"code":"61000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2727.0,"discounted_cash":1908.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UNLISTED PROCEDURE LARYNX","code_information":[{"code":"Px00036100063","type":"CDM"},{"code":"31599","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":567.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":811.0,"discounted_cash":567.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DSTR W NEUROL OTH PERIP NR","code_information":[{"code":"Px00036100072","type":"CDM"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":2096.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY CDM","code_information":[{"code":"Px00036100076","type":"CDM"},{"code":"33995","type":"HCPCS"}],"standard_charges":[{"gross_charge":1879.0,"discounted_cash":1315.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":619.0,"discounted_cash":433.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5156.0,"discounted_cash":3609.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IRE ABLATION 1+TUMORS PER ORGAN W/IMG GDN PERQ CDM","code_information":[{"code":"Px00036100085","type":"CDM"},{"code":"0600T","type":"HCPCS"}],"standard_charges":[{"gross_charge":31674.0,"discounted_cash":22171.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IRE ABLATION 1+TUMORS PR ORGN W/FLUOR&US GDN OPN CDM","code_information":[{"code":"Px00036100086","type":"CDM"},{"code":"0601T","type":"HCPCS"}],"standard_charges":[{"gross_charge":31674.0,"discounted_cash":22171.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE","code_information":[{"code":"Px00036100087","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1605.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS","code_information":[{"code":"Px00036100091","type":"CDM"},{"code":"64681","type":"HCPCS"}],"standard_charges":[{"gross_charge":2929.0,"discounted_cash":2050.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RENAL NDSC NEPHROTOMY W/BIOPSY","code_information":[{"code":"Px00036100093","type":"CDM"},{"code":"50574","type":"HCPCS"}],"standard_charges":[{"gross_charge":9569.0,"discounted_cash":6698.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","code_information":[{"code":"Px00036100096","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":515.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY OF UTERUS LINING","code_information":[{"code":"Px00036100098","type":"CDM"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PARTIAL EXCISION BONE PHALANX TOE","code_information":[{"code":"Px00036100105","type":"CDM"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THERMAL DSTRJ INTRAOSSEOUS BVN 1ST 2 LMBR/SAC CDM","code_information":[{"code":"Px00036100128","type":"CDM"},{"code":"64628","type":"HCPCS"}],"standard_charges":[{"gross_charge":53214.0,"discounted_cash":37249.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THERMAL DSTRJ INTRAOSSEOUS BVN EA ADDL LMBR/SAC CDM","code_information":[{"code":"Px00036100129","type":"CDM"},{"code":"64629","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":595.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ","code_information":[{"code":"Px00036100141","type":"CDM"},{"code":"61001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2742.0,"discounted_cash":1919.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDR","code_information":[{"code":"Px00036100148","type":"CDM"},{"code":"61154","type":"HCPCS"}],"standard_charges":[{"gross_charge":4203.0,"discounted_cash":2942.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RPLCMT/IRRIGATION VENTRICULAR CATHETER","code_information":[{"code":"Px00036100149","type":"CDM"},{"code":"62225","type":"HCPCS"}],"standard_charges":[{"gross_charge":19234.0,"discounted_cash":13463.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOCK ESP LUMBAR INCLUDES IMG GUIDANCE  CDM","code_information":[{"code":"Px00036100153","type":"CDM"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":856.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONTROL OF NOSEBLEED CDM","code_information":[{"code":"Px00036100189","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPAIR INTMD WND S/TR/EXT LTE 2.5CM CDM","code_information":[{"code":"Px00036100226","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BILIARY ENDOSCOPY INTRAOPERATIVE ADD-ON CDM","code_information":[{"code":"Px00036100236","type":"CDM"},{"code":"47550","type":"HCPCS"}],"standard_charges":[{"gross_charge":7132.0,"discounted_cash":4992.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RENAL ENDOSCOPY NDSC NFROT/PLOT W/ENDOPYELOTOMY CDM","code_information":[{"code":"Px00036100237","type":"CDM"},{"code":"50575","type":"HCPCS"}],"standard_charges":[{"gross_charge":13139.0,"discounted_cash":9197.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","code_information":[{"code":"Px00036100252","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION ANESTH AGENT&/STERIOD LUMBAR PLEXUS CONT INFS BY CA","code_information":[{"code":"Px00036100273","type":"CDM"},{"code":"64449","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":475.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3366.0,"discounted_cash":2356.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TEMPORARY CLOSURE EYELIDS SUTURE CDM","code_information":[{"code":"Px00036100276","type":"CDM"},{"code":"67875","type":"HCPCS"}],"standard_charges":[{"gross_charge":3304.0,"discounted_cash":2312.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4385.0,"discounted_cash":3069.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20009.0,"discounted_cash":14006.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":41348.0,"discounted_cash":28943.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":27442.0,"discounted_cash":19209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19814.0,"discounted_cash":13869.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19814.0,"discounted_cash":13869.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12367.0,"discounted_cash":8656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12367.0,"discounted_cash":8656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19249.0,"discounted_cash":13474.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17003.0,"discounted_cash":11902.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":27442.0,"discounted_cash":19209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":21007.0,"discounted_cash":14704.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":28474.0,"discounted_cash":19931.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24113.0,"discounted_cash":16879.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY PROSTATE INCISIONAL ANY APPROACH CDM","code_information":[{"code":"Px00036100340","type":"CDM"},{"code":"55705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1635.0,"discounted_cash":1144.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":939.0,"discounted_cash":657.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":774.0,"discounted_cash":541.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ABLATE PULM TUMOR PERQ CRYBL","code_information":[{"code":"Px00036110006","type":"CDM"},{"code":"32994","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6313.0,"discounted_cash":4419.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SEL CATH PLCM 3RD ORD","code_information":[{"code":"Px00036110037","type":"CDM"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":3658.0,"discounted_cash":2560.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NASAL/OROGASTRIC W/TUBE PLMT","code_information":[{"code":"Px00036110042","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":1000.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":649.0,"discounted_cash":454.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"Px00036110071","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.0,"discounted_cash":1288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1517.0,"discounted_cash":1061.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECT EPIDURAL PATCH","code_information":[{"code":"Px00036110072","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FRENOTOMY LINGUAL CDM","code_information":[{"code":"Px00036110073","type":"CDM"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":5178.0,"discounted_cash":3624.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTUBATION ENDOTRACHEAL","code_information":[{"code":"Px00036110077","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRACHEOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110092","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":741.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY SOFT TISSUE OF BACK DEEP","code_information":[{"code":"Px00036110097","type":"CDM"},{"code":"21925","type":"HCPCS"}],"standard_charges":[{"gross_charge":8679.0,"discounted_cash":6075.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7169.0,"discounted_cash":5018.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT DRUG IMPLANT DEVICE","code_information":[{"code":"Px00036110100","type":"CDM"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BONE MARROW ASPIRATION","code_information":[{"code":"Px00036110101","type":"CDM"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3313.0,"discounted_cash":2319.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2737.0,"discounted_cash":1915.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD/LYMPH SYSTEM PROCEDURE","code_information":[{"code":"Px00036110103","type":"CDM"},{"code":"38999","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":653.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPOSITION GASTROSTOMY TUBE","code_information":[{"code":"Px00036110104","type":"CDM"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"discounted_cash":2356.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2781.0,"discounted_cash":1946.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRO GASTROINTESTINAL TUBE","code_information":[{"code":"Px00036110105","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1842.0,"discounted_cash":1289.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1081.0,"discounted_cash":756.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION ABDOMINAL SHUNT","code_information":[{"code":"Px00036110111","type":"CDM"},{"code":"49427","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":452.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLACE GASTROSTOMY TUBE PERC","code_information":[{"code":"Px00036110112","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":4842.0,"discounted_cash":3389.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4002.0,"discounted_cash":2801.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHANGE G-TUBE TO G-J PERC","code_information":[{"code":"Px00036110113","type":"CDM"},{"code":"49446","type":"HCPCS"}],"standard_charges":[{"gross_charge":4424.0,"discounted_cash":3096.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4002.0,"discounted_cash":2801.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACE G/C TUBE PERC","code_information":[{"code":"Px00036110114","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1605.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1896.0,"discounted_cash":1327.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1842.0,"discounted_cash":1289.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"Px00036110116","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1605.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1896.0,"discounted_cash":1327.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE","code_information":[{"code":"Px00036110117","type":"CDM"},{"code":"49460","type":"HCPCS"}],"standard_charges":[{"gross_charge":1767.0,"discounted_cash":1236.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1462.0,"discounted_cash":1023.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FLUORO EXAM OF G/COLON TUBE","code_information":[{"code":"Px00036110118","type":"CDM"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":649.0,"discounted_cash":454.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION FOR URETER X-RAY THRU CATH","code_information":[{"code":"Px00036110120","type":"CDM"},{"code":"50684","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR URETER X-RAY","code_information":[{"code":"Px00036110121","type":"CDM"},{"code":"50690","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"Px00036110122","type":"CDM"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":965.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":659.0,"discounted_cash":461.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR MYELOGRAM","code_information":[{"code":"Px00036110126","type":"CDM"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1307.0,"discounted_cash":914.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":434.0,"discounted_cash":303.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERQ SACRAL AUGMT UNILAT INJ W/ IMG GUIDE & BONE BIOPSY","code_information":[{"code":"Px00036110136","type":"CDM"},{"code":"0200T","type":"HCPCS"}],"standard_charges":[{"gross_charge":11666.0,"discounted_cash":8166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9639.0,"discounted_cash":6747.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERQ SACRAL AUGMT BILAT INJ W/ IMG GUIDE & BONE BIOPSY","code_information":[{"code":"Px00036110137","type":"CDM"},{"code":"0201T","type":"HCPCS"}],"standard_charges":[{"gross_charge":22519.0,"discounted_cash":15763.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC RENAL ART","code_information":[{"code":"Px00036110138","type":"CDM"},{"code":"0234T","type":"HCPCS"}],"standard_charges":[{"gross_charge":32526.0,"discounted_cash":22768.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26870.0,"discounted_cash":18809.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRLUML PERIP ATHRC VISCERAL","code_information":[{"code":"Px00036110139","type":"CDM"},{"code":"0235T","type":"HCPCS"}],"standard_charges":[{"gross_charge":25768.0,"discounted_cash":18037.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC ABD AORTA","code_information":[{"code":"Px00036110140","type":"CDM"},{"code":"0236T","type":"HCPCS"}],"standard_charges":[{"gross_charge":32526.0,"discounted_cash":22768.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26870.0,"discounted_cash":18809.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":32526.0,"discounted_cash":22768.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26870.0,"discounted_cash":18809.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRLUML PERIP ATHRC ILIAC ART","code_information":[{"code":"Px00036110142","type":"CDM"},{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"gross_charge":32526.0,"discounted_cash":22768.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":26870.0,"discounted_cash":18809.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERC NEEDLE BIOPSY CHEST LINING","code_information":[{"code":"Px00036110158","type":"CDM"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":3012.0,"discounted_cash":2108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2491.0,"discounted_cash":1743.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT PLEURAL CATH","code_information":[{"code":"Px00036110166","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":10201.0,"discounted_cash":7140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8428.0,"discounted_cash":5899.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LYSE CHEST FIBRIN INIT DAY","code_information":[{"code":"Px00036110167","type":"CDM"},{"code":"32561","type":"HCPCS"}],"standard_charges":[{"gross_charge":1917.0,"discounted_cash":1341.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN SUBQ DAY","code_information":[{"code":"Px00036110168","type":"CDM"},{"code":"32562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1917.0,"discounted_cash":1341.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION OF HEART PACEMAKER","code_information":[{"code":"Px00036110169","type":"CDM"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":23806.0,"discounted_cash":16664.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10376.0,"discounted_cash":7263.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION PERM HEART PACEMAKER","code_information":[{"code":"Px00036110170","type":"CDM"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":47686.0,"discounted_cash":33380.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10972.0,"discounted_cash":7680.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION PERM AV PACER","code_information":[{"code":"Px00036110171","type":"CDM"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":23214.0,"discounted_cash":16249.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11451.0,"discounted_cash":8015.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION OF HEART ELECTRODE 33210","code_information":[{"code":"Px00036110172","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9563.0,"discounted_cash":6694.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION OF DUAL PACEMAKER","code_information":[{"code":"Px00036110174","type":"CDM"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":31970.0,"discounted_cash":22379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9290.0,"discounted_cash":6503.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION OF PULSE GENERATOR","code_information":[{"code":"Px00036110175","type":"CDM"},{"code":"33212","type":"HCPCS"}],"standard_charges":[{"gross_charge":33717.0,"discounted_cash":23601.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9666.0,"discounted_cash":6766.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACE DUAL CHAMBER PACER","code_information":[{"code":"Px00036110176","type":"CDM"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":42146.0,"discounted_cash":29502.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":21074.0,"discounted_cash":14751.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UPGRADE OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110178","type":"CDM"},{"code":"33214","type":"HCPCS"}],"standard_charges":[{"gross_charge":22549.0,"discounted_cash":15784.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11123.0,"discounted_cash":7786.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPOSITION PACING-IMPLANTABLE DEFIB LEAD","code_information":[{"code":"Px00036110179","type":"CDM"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":6704.0,"discounted_cash":4692.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5632.0,"discounted_cash":3942.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT 1 ELECTRODE PM-IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110180","type":"CDM"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":9290.0,"discounted_cash":6503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9290.0,"discounted_cash":6503.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT 2 ELECTRODE PM-IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110181","type":"CDM"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":9290.0,"discounted_cash":6503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9290.0,"discounted_cash":6503.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPAIR LEAD PACE- IMPLANTABLE DEFIB ONE","code_information":[{"code":"Px00036110182","type":"CDM"},{"code":"33218","type":"HCPCS"}],"standard_charges":[{"gross_charge":8106.0,"discounted_cash":5674.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPAIR LEAD PACE-IMPLANTABLE DEFIB DUAL","code_information":[{"code":"Px00036110183","type":"CDM"},{"code":"33220","type":"HCPCS"}],"standard_charges":[{"gross_charge":7048.0,"discounted_cash":4933.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RELOCATION POCKET PACEMAKER","code_information":[{"code":"Px00036110184","type":"CDM"},{"code":"33222","type":"HCPCS"}],"standard_charges":[{"gross_charge":6990.0,"discounted_cash":4893.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5230.0,"discounted_cash":3661.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RELOCATE POCKET FOR IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110185","type":"CDM"},{"code":"33223","type":"HCPCS"}],"standard_charges":[{"gross_charge":5230.0,"discounted_cash":3661.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5230.0,"discounted_cash":3661.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT PACING LEAD & CONNECT","code_information":[{"code":"Px00036110186","type":"CDM"},{"code":"33224","type":"HCPCS"}],"standard_charges":[{"gross_charge":11123.0,"discounted_cash":7786.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11123.0,"discounted_cash":7786.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC L VENTRIC PACING LEAD ADD-ON","code_information":[{"code":"Px00036110187","type":"CDM"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":11238.0,"discounted_cash":7866.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11238.0,"discounted_cash":7866.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPOSITION L VENTRIC LEAD","code_information":[{"code":"Px00036110188","type":"CDM"},{"code":"33226","type":"HCPCS"}],"standard_charges":[{"gross_charge":5632.0,"discounted_cash":3942.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5632.0,"discounted_cash":3942.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110189","type":"CDM"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":6486.0,"discounted_cash":4540.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6486.0,"discounted_cash":4540.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE PACER PERM SINGLE LEAD","code_information":[{"code":"Px00036110191","type":"CDM"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL PACEMAKER ELECTRODE","code_information":[{"code":"Px00036110192","type":"CDM"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT PULSE GENERATOR","code_information":[{"code":"Px00036110193","type":"CDM"},{"code":"33240","type":"HCPCS"}],"standard_charges":[{"gross_charge":45240.0,"discounted_cash":31668.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":18240.0,"discounted_cash":12768.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE PULSE GENERATOR","code_information":[{"code":"Px00036110194","type":"CDM"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE ELTRD TRANSVEN","code_information":[{"code":"Px00036110195","type":"CDM"},{"code":"33244","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6133.0,"discounted_cash":4293.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELTRD/INSERT PACE-DEFIB","code_information":[{"code":"Px00036110196","type":"CDM"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":57996.0,"discounted_cash":40597.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":21952.0,"discounted_cash":15366.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPAIR OF HEART WOUND","code_information":[{"code":"Px00036110199","type":"CDM"},{"code":"33300","type":"HCPCS"}],"standard_charges":[{"gross_charge":10624.0,"discounted_cash":7436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOVASC TAA REPR INCL SUBCL","code_information":[{"code":"Px00036110200","type":"CDM"},{"code":"33880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5077.0,"discounted_cash":3553.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","code_information":[{"code":"Px00036110217","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":850.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":793.0,"discounted_cash":555.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CANNULATION THORACIC DUCT","code_information":[{"code":"Px00036110230","type":"CDM"},{"code":"38794","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2770.0,"discounted_cash":1939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2290.0,"discounted_cash":1603.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL","code_information":[{"code":"Px00036110240","type":"CDM"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2077.0,"discounted_cash":1453.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1717.0,"discounted_cash":1201.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2770.0,"discounted_cash":1939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2290.0,"discounted_cash":1603.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2077.0,"discounted_cash":1453.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1717.0,"discounted_cash":1201.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2077.0,"discounted_cash":1453.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1717.0,"discounted_cash":1201.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2770.0,"discounted_cash":1939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2290.0,"discounted_cash":1603.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2077.0,"discounted_cash":1453.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1717.0,"discounted_cash":1201.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/MR GDN 1ST LESION","code_information":[{"code":"Px00036110246","type":"CDM"},{"code":"10011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2852.0,"discounted_cash":1996.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2357.0,"discounted_cash":1649.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL","code_information":[{"code":"Px00036110247","type":"CDM"},{"code":"10012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2077.0,"discounted_cash":1453.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1717.0,"discounted_cash":1201.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110248","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":698.0,"discounted_cash":488.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110249","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":524.0,"discounted_cash":366.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110250","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":719.0,"discounted_cash":503.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110251","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":540.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110252","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1965.0,"discounted_cash":1375.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1242.0,"discounted_cash":869.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1128.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":933.0,"discounted_cash":653.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":79480.0,"discounted_cash":55636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":65657.0,"discounted_cash":45959.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HTCAT REMOVAL PERM LEADLESS PACEMAKER R VENTR","code_information":[{"code":"Px00036110255","type":"CDM"},{"code":"33275","type":"HCPCS"}],"standard_charges":[{"gross_charge":14699.0,"discounted_cash":10289.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12141.0,"discounted_cash":8498.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG","code_information":[{"code":"Px00036110256","type":"CDM"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":38327.0,"discounted_cash":26828.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":31662.0,"discounted_cash":22163.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR","code_information":[{"code":"Px00036110257","type":"CDM"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":2481.0,"discounted_cash":1736.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2481.0,"discounted_cash":1736.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR","code_information":[{"code":"Px00036110258","type":"CDM"},{"code":"33289","type":"HCPCS"}],"standard_charges":[{"gross_charge":151874.0,"discounted_cash":106311.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":125459.0,"discounted_cash":87821.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2883.0,"discounted_cash":2018.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2380.0,"discounted_cash":1666.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"Px00036110260","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":5383.0,"discounted_cash":3768.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4448.0,"discounted_cash":3113.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES","code_information":[{"code":"Px00036110261","type":"CDM"},{"code":"38531","type":"HCPCS"}],"standard_charges":[{"gross_charge":13461.0,"discounted_cash":9422.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11120.0,"discounted_cash":7784.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG","code_information":[{"code":"Px00036110262","type":"CDM"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":9315.0,"discounted_cash":6520.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7696.0,"discounted_cash":5387.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":15668.0,"discounted_cash":10967.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12945.0,"discounted_cash":9061.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION WRLS CAR STIMULATOR LV PACG COMPL SYS","code_information":[{"code":"Px00036110264","type":"CDM"},{"code":"0515T","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION WRLS CAR STIMULATOR LV PACG ELTRD ONLY","code_information":[{"code":"Px00036110265","type":"CDM"},{"code":"0516T","type":"HCPCS"}],"standard_charges":[{"gross_charge":31662.0,"discounted_cash":22163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":31662.0,"discounted_cash":22163.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION WRLS CAR STIMULATOR LV PACG PG BATT","code_information":[{"code":"Px00036110266","type":"CDM"},{"code":"0517T","type":"HCPCS"}],"standard_charges":[{"gross_charge":31662.0,"discounted_cash":22163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":31662.0,"discounted_cash":22163.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL PG WRLS CAR STIMULATOR","code_information":[{"code":"Px00036110267","type":"CDM"},{"code":"0518T","type":"HCPCS"}],"standard_charges":[{"gross_charge":13387.0,"discounted_cash":9370.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":13387.0,"discounted_cash":9370.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL&RPLCMT WRLS CAR STIMULAT","code_information":[{"code":"Px00036110268","type":"CDM"},{"code":"0519T","type":"HCPCS"}],"standard_charges":[{"gross_charge":13387.0,"discounted_cash":9370.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":13387.0,"discounted_cash":9370.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL&RPLCMT WRLS CAR STIMULATOR W/DEV INTERROG/PROG","code_information":[{"code":"Px00036110269","type":"CDM"},{"code":"0520T","type":"HCPCS"}],"standard_charges":[{"gross_charge":94057.0,"discounted_cash":65839.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94057.0,"discounted_cash":65839.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTERROG DEV EVAL WRLS CAR STIMULATOR IN PERSON","code_information":[{"code":"Px00036110270","type":"CDM"},{"code":"0521T","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":72.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PRGRMG DEVICE EVAL WRLS CAR STIMULATOR IN PERSON","code_information":[{"code":"Px00036110271","type":"CDM"},{"code":"0522T","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":154.0,"discounted_cash":107.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING","code_information":[{"code":"Px00036110272","type":"CDM"},{"code":"0523T","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":120.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EV CATHETER DIR CHEM ABLTJ INCMPTNT XTR VEIN","code_information":[{"code":"Px00036110273","type":"CDM"},{"code":"0524T","type":"HCPCS"}],"standard_charges":[{"gross_charge":11296.0,"discounted_cash":7907.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION/REPLACEMENT COMPLETE IIMS","code_information":[{"code":"Px00036110274","type":"CDM"},{"code":"0525T","type":"HCPCS"}],"standard_charges":[{"gross_charge":42246.0,"discounted_cash":29572.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION/REPLACEMENT IIMS ELECTRODE ONLY","code_information":[{"code":"Px00036110275","type":"CDM"},{"code":"0526T","type":"HCPCS"}],"standard_charges":[{"gross_charge":31662.0,"discounted_cash":22163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION/REPLACEMENT IIMS IMPLANTABLE MNTR ONLY","code_information":[{"code":"Px00036110276","type":"CDM"},{"code":"0527T","type":"HCPCS"}],"standard_charges":[{"gross_charge":31662.0,"discounted_cash":22163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL COMPLETE IIMS INCL IMG S&I","code_information":[{"code":"Px00036110277","type":"CDM"},{"code":"0530T","type":"HCPCS"}],"standard_charges":[{"gross_charge":13387.0,"discounted_cash":9370.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL IIMS ELECTRODE ONLY INCL IMG S&I","code_information":[{"code":"Px00036110278","type":"CDM"},{"code":"0531T","type":"HCPCS"}],"standard_charges":[{"gross_charge":13387.0,"discounted_cash":9370.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL IIMS IMPLANTABLE MNTR ONLY INCL IMG S&I","code_information":[{"code":"Px00036110279","type":"CDM"},{"code":"0532T","type":"HCPCS"}],"standard_charges":[{"gross_charge":13387.0,"discounted_cash":9370.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110283","type":"CDM"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":933.0,"discounted_cash":653.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THERAPEUTIC APHERESIS WHITE BLOOD CELLS CDM","code_information":[{"code":"Px00036110291","type":"CDM"},{"code":"36511","type":"HCPCS"}],"standard_charges":[{"gross_charge":4998.0,"discounted_cash":3498.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLATELETS CDM","code_information":[{"code":"Px00036110292","type":"CDM"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":1594.0,"discounted_cash":1115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOVASC TAA REPR W/O SUBCL","code_information":[{"code":"Px00036110362","type":"CDM"},{"code":"33881","type":"HCPCS"}],"standard_charges":[{"gross_charge":12038.0,"discounted_cash":8426.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL IMPLANTABLE DEVICE","code_information":[{"code":"Px00036110366","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":4459.0,"discounted_cash":3121.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1842.0,"discounted_cash":1289.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE AORTIC ASSIST DEVICE","code_information":[{"code":"Px00036110367","type":"CDM"},{"code":"33968","type":"HCPCS"}],"standard_charges":[{"gross_charge":3816.0,"discounted_cash":2671.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMPLANT VENTRICULAR DEVICE","code_information":[{"code":"Px00036110368","type":"CDM"},{"code":"33975","type":"HCPCS"}],"standard_charges":[{"gross_charge":4112.0,"discounted_cash":2878.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVE VENTRICULAR DEVICE","code_information":[{"code":"Px00036110369","type":"CDM"},{"code":"33977","type":"HCPCS"}],"standard_charges":[{"gross_charge":4469.0,"discounted_cash":3128.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PSEUDOANEURYSM INJECTION TRT","code_information":[{"code":"Px00036110385","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2140.0,"discounted_cash":1498.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":731.0,"discounted_cash":511.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION EXT VENOGRAPHY","code_information":[{"code":"Px00036110386","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":466.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLACE CATHETER IN VEIN","code_information":[{"code":"Px00036110388","type":"CDM"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1385.0,"discounted_cash":969.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOUS PLACEMENT 1ST ORDER","code_information":[{"code":"Px00036110389","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.0,"discounted_cash":1032.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SLCT CATH 2ND VENOUS","code_information":[{"code":"Px00036110390","type":"CDM"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1400.0,"discounted_cash":980.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":808.0,"discounted_cash":565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RT/LT PULMONARY PLACEMENT","code_information":[{"code":"Px00036110392","type":"CDM"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1666.0,"discounted_cash":1166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SELECT SEGMENTAL PULMONARY ART","code_information":[{"code":"Px00036110393","type":"CDM"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":1000.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO CATH EXTRM ART","code_information":[{"code":"Px00036110397","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2765.0,"discounted_cash":1935.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE","code_information":[{"code":"Px00036110398","type":"CDM"},{"code":"61107","type":"HCPCS"}],"standard_charges":[{"gross_charge":1341.0,"discounted_cash":938.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTABLISH ACCESS TO AORTA","code_information":[{"code":"Px00036110401","type":"CDM"},{"code":"36160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLACE CATHETER IN AORTA","code_information":[{"code":"Px00036110402","type":"CDM"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.0,"discounted_cash":1965.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2706.0,"discounted_cash":1894.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110404","type":"CDM"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":2982.0,"discounted_cash":2087.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UMBILICAL BEIN SAMPLING ASSIST","code_information":[{"code":"Px00036110405","type":"CDM"},{"code":"59012","type":"HCPCS"}],"standard_charges":[{"gross_charge":8042.0,"discounted_cash":5629.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":791.0,"discounted_cash":553.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BRACHIOCEPHALIC ANGIO ADDT","code_information":[{"code":"Px00036110406","type":"CDM"},{"code":"36218","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 1ST ORDER","code_information":[{"code":"Px00036110408","type":"CDM"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":2927.0,"discounted_cash":2048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110409","type":"CDM"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":3115.0,"discounted_cash":2180.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 3RD ORDER","code_information":[{"code":"Px00036110410","type":"CDM"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":3713.0,"discounted_cash":2599.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO ADDT","code_information":[{"code":"Px00036110411","type":"CDM"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VESSEL INJECTION PROCEDURE","code_information":[{"code":"Px00036110413","type":"CDM"},{"code":"36299","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION OF CATHETER VEIN","code_information":[{"code":"Px00036110416","type":"CDM"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":2518.0,"discounted_cash":1762.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION OF CATHETER VEIN FOR SAMPLING","code_information":[{"code":"Px00036110417","type":"CDM"},{"code":"36500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":917.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4095.0,"discounted_cash":2866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15","code_information":[{"code":"Px00036110420","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":303.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT","code_information":[{"code":"Px00036110423","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":1450.0,"discounted_cash":1015.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT TUNNELED CVC W/O SQ PORT/PMP/YOUNGER THAN 5 YRS","code_information":[{"code":"Px00036110424","type":"CDM"},{"code":"36557","type":"HCPCS"}],"standard_charges":[{"gross_charge":8922.0,"discounted_cash":6245.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5454.0,"discounted_cash":3817.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT TUNNELED CV CATH > 5","code_information":[{"code":"Px00036110425","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":8231.0,"discounted_cash":5761.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5454.0,"discounted_cash":3817.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSJ TUNNELED CTR VAD W/SUBQ PORT YOUNGER THAN 5 YRS","code_information":[{"code":"Px00036110426","type":"CDM"},{"code":"36560","type":"HCPCS"}],"standard_charges":[{"gross_charge":8435.0,"discounted_cash":5904.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6968.0,"discounted_cash":4877.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT TUNNELED CV CATH W/PORT > 5","code_information":[{"code":"Px00036110427","type":"CDM"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":9584.0,"discounted_cash":6708.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5784.0,"discounted_cash":4048.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT TUNNELED CV CATH W/SUBC PUMP","code_information":[{"code":"Px00036110429","type":"CDM"},{"code":"36563","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":4760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5618.0,"discounted_cash":3932.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INS TNELD CV ACCES DVCE W/2CATHS","code_information":[{"code":"Px00036110430","type":"CDM"},{"code":"36565","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":4760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5618.0,"discounted_cash":3932.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT PICC WO PORT PUMP LT 5 YR","code_information":[{"code":"Px00036110431","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":3715.0,"discounted_cash":2600.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3067.0,"discounted_cash":2146.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION PICC WO IMG GDN GTE 5 YR","code_information":[{"code":"Px00036110432","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":3785.0,"discounted_cash":2649.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT PICVAD CATH PEDS/YOUNGER THAN 5 YEARS","code_information":[{"code":"Px00036110435","type":"CDM"},{"code":"36570","type":"HCPCS"}],"standard_charges":[{"gross_charge":8667.0,"discounted_cash":6066.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5298.0,"discounted_cash":3708.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT PICVAD CATH > 5 YEARS","code_information":[{"code":"Px00036110436","type":"CDM"},{"code":"36571","type":"HCPCS"}],"standard_charges":[{"gross_charge":7931.0,"discounted_cash":5551.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5298.0,"discounted_cash":3708.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPAIR TUNNELED CV CATH","code_information":[{"code":"Px00036110437","type":"CDM"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1842.0,"discounted_cash":1289.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPAIR TUNNELED CV CATH W/PUMP OR PORT","code_information":[{"code":"Px00036110438","type":"CDM"},{"code":"36576","type":"HCPCS"}],"standard_charges":[{"gross_charge":3677.0,"discounted_cash":2573.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3036.0,"discounted_cash":2125.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACE TUNNELED CV CATH W/PUMP","code_information":[{"code":"Px00036110439","type":"CDM"},{"code":"36578","type":"HCPCS"}],"standard_charges":[{"gross_charge":10075.0,"discounted_cash":7052.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5298.0,"discounted_cash":3708.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACE NON TUNNEL CVAD CATH","code_information":[{"code":"Px00036110440","type":"CDM"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":3677.0,"discounted_cash":2573.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3036.0,"discounted_cash":2125.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACE TUNNELED CV CATH W/O PUMP","code_information":[{"code":"Px00036110441","type":"CDM"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":8858.0,"discounted_cash":6200.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5298.0,"discounted_cash":3708.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPLACE TUNNELED CV ACCESS DEVICE","code_information":[{"code":"Px00036110442","type":"CDM"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":10511.0,"discounted_cash":7357.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7174.0,"discounted_cash":5021.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLETE REPLACEMENT PICC RS&I","code_information":[{"code":"Px00036110443","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":3785.0,"discounted_cash":2649.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE TUNNEL CV CATH WO PORT PUMP","code_information":[{"code":"Px00036110445","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":4459.0,"discounted_cash":3121.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1842.0,"discounted_cash":1289.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00036110446","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT","code_information":[{"code":"Px00036110447","type":"CDM"},{"code":"67229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL","code_information":[{"code":"Px00036110448","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":5720.0,"discounted_cash":4004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4063.0,"discounted_cash":2844.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MECH REMOV TUNNELED CV CATH","code_information":[{"code":"Px00036110452","type":"CDM"},{"code":"36595","type":"HCPCS"}],"standard_charges":[{"gross_charge":7537.0,"discounted_cash":5275.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5298.0,"discounted_cash":3708.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MECH REMOV TUNNELED CV CATH THRU DEVICE LUMEN","code_information":[{"code":"Px00036110453","type":"CDM"},{"code":"36596","type":"HCPCS"}],"standard_charges":[{"gross_charge":3677.0,"discounted_cash":2573.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3036.0,"discounted_cash":2125.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPOSITION VENOUS CATHETER","code_information":[{"code":"Px00036110454","type":"CDM"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":5461.0,"discounted_cash":3822.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3036.0,"discounted_cash":2125.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJ W/FLUOR EVAL CV DEVICE","code_information":[{"code":"Px00036110455","type":"CDM"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":530.0,"discounted_cash":371.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","code_information":[{"code":"Px00036110456","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":693.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00036110457","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1206.0,"discounted_cash":844.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00036110459","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY CDM","code_information":[{"code":"Px00036110461","type":"CDM"},{"code":"33018","type":"HCPCS"}],"standard_charges":[{"gross_charge":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00036110462","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT HEPATIC SHUNT (TIPS)","code_information":[{"code":"Px00036110474","type":"CDM"},{"code":"37182","type":"HCPCS"}],"standard_charges":[{"gross_charge":26876.0,"discounted_cash":18813.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REVISE HEPATIC SHUNT TIPS","code_information":[{"code":"Px00036110475","type":"CDM"},{"code":"37183","type":"HCPCS"}],"standard_charges":[{"gross_charge":27854.0,"discounted_cash":19497.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":21566.0,"discounted_cash":15096.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PRIM ART MECH THROMBECTOMY","code_information":[{"code":"Px00036110476","type":"CDM"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":12148.0,"discounted_cash":8503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10046.0,"discounted_cash":7032.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PRIM ART M-THROMBECT ADD-ON","code_information":[{"code":"Px00036110477","type":"CDM"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5333.0,"discounted_cash":3733.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5181.0,"discounted_cash":3626.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOUS MECH THROMBECTOMY","code_information":[{"code":"Px00036110479","type":"CDM"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":12148.0,"discounted_cash":8503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10046.0,"discounted_cash":7032.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VENOUS M-THROMBECTOMY ADD-ON","code_information":[{"code":"Px00036110480","type":"CDM"},{"code":"37188","type":"HCPCS"}],"standard_charges":[{"gross_charge":11800.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9759.0,"discounted_cash":6831.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THROMBOLYTIC THERAPY STROKE","code_information":[{"code":"Px00036110481","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":484.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":692.0,"discounted_cash":484.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRANSCATHETER BIOPSY","code_information":[{"code":"Px00036110482","type":"CDM"},{"code":"37200","type":"HCPCS"}],"standard_charges":[{"gross_charge":6687.0,"discounted_cash":4680.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5530.0,"discounted_cash":3871.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRANSCATH STENT CCA W/EPS","code_information":[{"code":"Px00036110493","type":"CDM"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":24873.0,"discounted_cash":17411.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18443.0,"discounted_cash":12910.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ILIAC REVASC","code_information":[{"code":"Px00036110495","type":"CDM"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":20009.0,"discounted_cash":14006.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ILIAC REVASC W/STENT","code_information":[{"code":"Px00036110496","type":"CDM"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":41348.0,"discounted_cash":28943.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":19249.0,"discounted_cash":13474.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ILIAC REVASC ADD-ON","code_information":[{"code":"Px00036110497","type":"CDM"},{"code":"37222","type":"HCPCS"}],"standard_charges":[{"gross_charge":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ILIAC REVASC W/STENT ADD-ON","code_information":[{"code":"Px00036110498","type":"CDM"},{"code":"37223","type":"HCPCS"}],"standard_charges":[{"gross_charge":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FEM/POPL REVAS W/TLA","code_information":[{"code":"Px00036110499","type":"CDM"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FEM/POPL REVAS W/ATHER","code_information":[{"code":"Px00036110500","type":"CDM"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":28251.0,"discounted_cash":19775.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":19814.0,"discounted_cash":13869.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THERAPEUTIC APHERESIS RED BLOOD CELLS CDM","code_information":[{"code":"Px00036110501","type":"CDM"},{"code":"36512","type":"HCPCS"}],"standard_charges":[{"gross_charge":5464.0,"discounted_cash":3824.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4513.0,"discounted_cash":3159.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FEM/POPL REVASC W/STENT","code_information":[{"code":"Px00036110502","type":"CDM"},{"code":"37226","type":"HCPCS"}],"standard_charges":[{"gross_charge":27442.0,"discounted_cash":19209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":19249.0,"discounted_cash":13474.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FEM/POPL REVASC STNT & ATHER","code_information":[{"code":"Px00036110503","type":"CDM"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":47525.0,"discounted_cash":33267.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28474.0,"discounted_cash":19931.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TIB/PER REVASC W/TLA","code_information":[{"code":"Px00036110504","type":"CDM"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TIB/PER REVASC W/ATHER","code_information":[{"code":"Px00036110505","type":"CDM"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":27442.0,"discounted_cash":19209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":19249.0,"discounted_cash":13474.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TIB/PER REVASC W/STENT","code_information":[{"code":"Px00036110506","type":"CDM"},{"code":"37230","type":"HCPCS"}],"standard_charges":[{"gross_charge":27442.0,"discounted_cash":19209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":19249.0,"discounted_cash":13474.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TIB/PER REVASC STENT & ATHER","code_information":[{"code":"Px00036110507","type":"CDM"},{"code":"37231","type":"HCPCS"}],"standard_charges":[{"gross_charge":47525.0,"discounted_cash":33267.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":28474.0,"discounted_cash":19931.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TIB/PER REVASC ADD-ON","code_information":[{"code":"Px00036110508","type":"CDM"},{"code":"37232","type":"HCPCS"}],"standard_charges":[{"gross_charge":12927.0,"discounted_cash":9048.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TIBPER REVASC W/ATHER ADD-ON","code_information":[{"code":"Px00036110509","type":"CDM"},{"code":"37233","type":"HCPCS"}],"standard_charges":[{"gross_charge":21007.0,"discounted_cash":14704.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":14734.0,"discounted_cash":10313.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REVSC OPN/PRQ TIB/PERO STENT","code_information":[{"code":"Px00036110510","type":"CDM"},{"code":"37234","type":"HCPCS"}],"standard_charges":[{"gross_charge":17774.0,"discounted_cash":12441.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":17003.0,"discounted_cash":11902.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TIB/PER REVASC STNT & ATHER","code_information":[{"code":"Px00036110511","type":"CDM"},{"code":"37235","type":"HCPCS"}],"standard_charges":[{"gross_charge":25208.0,"discounted_cash":17645.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":24113.0,"discounted_cash":16879.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LARYNGOSCOPY FLEXIBLE DIAGNOSTIC","code_information":[{"code":"Px00036110516","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LIGATION OF A-V FISTULA","code_information":[{"code":"Px00036110518","type":"CDM"},{"code":"37607","type":"HCPCS"}],"standard_charges":[{"gross_charge":13515.0,"discounted_cash":9460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TEMPORAL ARTERY PROCEDURE","code_information":[{"code":"Px00036110519","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":5027.0,"discounted_cash":3518.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI CDM","code_information":[{"code":"Px00036110524","type":"CDM"},{"code":"34718","type":"HCPCS"}],"standard_charges":[{"gross_charge":15180.0,"discounted_cash":10626.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VASCULAR SURGERY PROCEDURE","code_information":[{"code":"Px00036110532","type":"CDM"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":3752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":312.0,"discounted_cash":218.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2635.0,"discounted_cash":1844.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT NON TUNNEL CV CATH LT 5 YR","code_information":[{"code":"Px00036110537","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3290.0,"discounted_cash":2303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SKIN TISSUE PROCEDURE IR","code_information":[{"code":"Px00036110549","type":"CDM"},{"code":"17999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1647.0,"discounted_cash":1152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":256.0,"discounted_cash":179.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SKIN TISSUE PROC","code_information":[{"code":"Px00036110552","type":"CDM"},{"code":"17999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1647.0,"discounted_cash":1152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":256.0,"discounted_cash":179.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYOSURG ABLATE FA EACH","code_information":[{"code":"Px00036110554","type":"CDM"},{"code":"19105","type":"HCPCS"}],"standard_charges":[{"gross_charge":10441.0,"discounted_cash":7308.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8640.0,"discounted_cash":6048.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC APPLICATION OF UNABOOT BIL","code_information":[{"code":"Px00036110555","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":608.0,"discounted_cash":425.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE SUPERFICIAL","code_information":[{"code":"Px00036110558","type":"CDM"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION OF SINUS TRACT","code_information":[{"code":"Px00036110559","type":"CDM"},{"code":"20500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2984.0,"discounted_cash":2088.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2254.0,"discounted_cash":1577.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC IR INJ TRIGGER POINT(S)1TO2 MUSC","code_information":[{"code":"Px00036110560","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":842.0,"discounted_cash":589.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1032.0,"discounted_cash":722.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":842.0,"discounted_cash":589.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TREATMENT OF BONE CYST","code_information":[{"code":"Px00036110563","type":"CDM"},{"code":"20615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1707.0,"discounted_cash":1194.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ABLATE BONE TUMOR(S) PERQ W/GUIDE RF ABLATION","code_information":[{"code":"Px00036110564","type":"CDM"},{"code":"20982","type":"HCPCS"}],"standard_charges":[{"gross_charge":15643.0,"discounted_cash":10950.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12924.0,"discounted_cash":9046.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MUSCULOSKELETAL SURGERY - UNLISTED","code_information":[{"code":"Px00036110565","type":"CDM"},{"code":"20999","type":"HCPCS"}],"standard_charges":[{"gross_charge":6497.0,"discounted_cash":4547.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5376.0,"discounted_cash":3763.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY OF NECK/CHEST - SOFT TISSUE","code_information":[{"code":"Px00036110567","type":"CDM"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4753.0,"discounted_cash":3327.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NECK/CHEST SURGERY PROCEDURE","code_information":[{"code":"Px00036110568","type":"CDM"},{"code":"21899","type":"HCPCS"}],"standard_charges":[{"gross_charge":7232.0,"discounted_cash":5062.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":280.0,"discounted_cash":196.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY SOFT TISSUE OF BACK","code_information":[{"code":"Px00036110569","type":"CDM"},{"code":"21920","type":"HCPCS"}],"standard_charges":[{"gross_charge":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2559.0,"discounted_cash":1791.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SPINE SURGERY PROCEDURE","code_information":[{"code":"Px00036110571","type":"CDM"},{"code":"22899","type":"HCPCS"}],"standard_charges":[{"gross_charge":9246.0,"discounted_cash":6472.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7648.0,"discounted_cash":5353.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY SHOULDER TISSUES","code_information":[{"code":"Px00036110572","type":"CDM"},{"code":"23065","type":"HCPCS"}],"standard_charges":[{"gross_charge":4705.0,"discounted_cash":3293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY SHOULDER TISSUES DEEP","code_information":[{"code":"Px00036110573","type":"CDM"},{"code":"23066","type":"HCPCS"}],"standard_charges":[{"gross_charge":8679.0,"discounted_cash":6075.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7169.0,"discounted_cash":5018.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"Px00036110575","type":"CDM"},{"code":"24065","type":"HCPCS"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4753.0,"discounted_cash":3327.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY ARM/ELBOW SOFT TISSUE DEEP","code_information":[{"code":"Px00036110576","type":"CDM"},{"code":"24066","type":"HCPCS"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4753.0,"discounted_cash":3327.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2251.0,"discounted_cash":1575.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RENAL ARTERY 1ST ORD W/S&I UNILATERAL","code_information":[{"code":"Px00036110581","type":"CDM"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":7763.0,"discounted_cash":5434.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6457.0,"discounted_cash":4519.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RENAL ARTERY 1ST ORD W/S&I BILATERAL","code_information":[{"code":"Px00036110582","type":"CDM"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":10097.0,"discounted_cash":7067.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":9983.0,"discounted_cash":6988.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6457.0,"discounted_cash":4519.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":12938.0,"discounted_cash":9056.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6272.0,"discounted_cash":4390.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERTION IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110585","type":"CDM"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":13797.0,"discounted_cash":9657.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6072.0,"discounted_cash":4250.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVAL IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110586","type":"CDM"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":12084.0,"discounted_cash":8458.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6595.0,"discounted_cash":4616.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"Px00036110601","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":6031.0,"discounted_cash":4221.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3740.0,"discounted_cash":2618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":663.0,"discounted_cash":464.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPLEX DRAINAGE WOUND","code_information":[{"code":"Px00036110603","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":7849.0,"discounted_cash":5494.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6484.0,"discounted_cash":4538.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS","code_information":[{"code":"Px00036110604","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS","code_information":[{"code":"Px00036110605","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":445.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPAIR SUPERFICIAL WOUND(S) 2.5 TO 7.5 CM","code_information":[{"code":"Px00036110606","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY MUSCLE PERCUTANEOUS NEEDLE CDM","code_information":[{"code":"Px00036110610","type":"CDM"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.0,"discounted_cash":2369.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2796.0,"discounted_cash":1957.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"Px00036110611","type":"CDM"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5922.0,"discounted_cash":4145.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4893.0,"discounted_cash":3425.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00036110619","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":530.0,"discounted_cash":371.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"Px00036110622","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2437.0,"discounted_cash":1705.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2013.0,"discounted_cash":1409.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHEST SURGERY PROCEDURE","code_information":[{"code":"Px00036110624","type":"CDM"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.0,"discounted_cash":1379.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1555.0,"discounted_cash":1088.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPAIR BLOOD VESSEL LESION","code_information":[{"code":"Px00036110629","type":"CDM"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2444.0,"discounted_cash":1710.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2444.0,"discounted_cash":1710.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERCUTANEOUS IMPLANTATION/REPLACEMENT ISDNS PTN CDM","code_information":[{"code":"Px00036110630","type":"CDM"},{"code":"0587T","type":"HCPCS"}],"standard_charges":[{"gross_charge":4281.0,"discounted_cash":2996.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REVISION OR REMOVAL ISDNS POSTERIOR TIBIAL NRV CDM","code_information":[{"code":"Px00036110631","type":"CDM"},{"code":"0588T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.0,"discounted_cash":1298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRODUCTION NEEDLE/INTRACATHETER VEIN","code_information":[{"code":"Px00036110641","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION THERAPY OF VEIN","code_information":[{"code":"Px00036110642","type":"CDM"},{"code":"36470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR SPLEEN X-RAY","code_information":[{"code":"Px00036110643","type":"CDM"},{"code":"38200","type":"HCPCS"}],"standard_charges":[{"gross_charge":6673.0,"discounted_cash":4671.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THROAT SURGERY PROCEDURE","code_information":[{"code":"Px00036110644","type":"CDM"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":627.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":280.0,"discounted_cash":196.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"Px00036110645","type":"CDM"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2807.0,"discounted_cash":1964.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2807.0,"discounted_cash":1964.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00036110646","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"Px00036110655","type":"CDM"},{"code":"47552","type":"HCPCS"}],"standard_charges":[{"gross_charge":9672.0,"discounted_cash":6770.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERC DILATION BILIARY W/O STENT","code_information":[{"code":"Px00036110656","type":"CDM"},{"code":"47555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3887.0,"discounted_cash":2720.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3692.0,"discounted_cash":2584.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERC DILATION BILIARY W/ STENT","code_information":[{"code":"Px00036110657","type":"CDM"},{"code":"47556","type":"HCPCS"}],"standard_charges":[{"gross_charge":12371.0,"discounted_cash":8659.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY PANCREAS","code_information":[{"code":"Px00036110659","type":"CDM"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":3012.0,"discounted_cash":2108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2491.0,"discounted_cash":1743.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036110662","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3431.0,"discounted_cash":2401.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1601.0,"discounted_cash":1120.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY ABDOMINAL MASS","code_information":[{"code":"Px00036110664","type":"CDM"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":2660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3139.0,"discounted_cash":2197.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AIR INJECTION INTO ABDOMEN","code_information":[{"code":"Px00036110666","type":"CDM"},{"code":"49400","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":541.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT TUN INTRAPERITONEAL CATH PERC","code_information":[{"code":"Px00036110667","type":"CDM"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":10501.0,"discounted_cash":7350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8676.0,"discounted_cash":6073.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INS TUN IP CATH FOR DIAL OPN","code_information":[{"code":"Px00036110669","type":"CDM"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":11027.0,"discounted_cash":7718.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6687.0,"discounted_cash":4680.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE TUNNELED IP CATH","code_information":[{"code":"Px00036110670","type":"CDM"},{"code":"49422","type":"HCPCS"}],"standard_charges":[{"gross_charge":7417.0,"discounted_cash":5191.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6128.0,"discounted_cash":4289.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXCHANGE DRAINAGE CATHETER","code_information":[{"code":"Px00036110671","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":5287.0,"discounted_cash":3700.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3423.0,"discounted_cash":2396.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RENAL BIOPSY PERQ","code_information":[{"code":"Px00036110673","type":"CDM"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3913.0,"discounted_cash":2739.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3232.0,"discounted_cash":2262.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRAINAGE OF KIDNEY LESION","code_information":[{"code":"Px00036110677","type":"CDM"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":2660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3139.0,"discounted_cash":2197.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRAIN BLADDER W/CATH INSERTION","code_information":[{"code":"Px00036110683","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":6838.0,"discounted_cash":4786.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5650.0,"discounted_cash":3955.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYSTOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110687","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":896.0,"discounted_cash":627.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHANGE OF BLADDER TUBE","code_information":[{"code":"Px00036110688","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":5548.0,"discounted_cash":3883.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1842.0,"discounted_cash":1289.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UROLOGY SURGERY PROCEDURE","code_information":[{"code":"Px00036110692","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION INTO BRAIN CANAL","code_information":[{"code":"Px00036110695","type":"CDM"},{"code":"61055","type":"HCPCS"}],"standard_charges":[{"gross_charge":7765.0,"discounted_cash":5435.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6414.0,"discounted_cash":4489.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX","code_information":[{"code":"Px00036110696","type":"CDM"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1842.0,"discounted_cash":1289.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRANSCATH OCCLUSION CNS","code_information":[{"code":"Px00036110698","type":"CDM"},{"code":"61624","type":"HCPCS"}],"standard_charges":[{"gross_charge":5305.0,"discounted_cash":3713.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRANSCATH OCCLUSION NON-CNS","code_information":[{"code":"Px00036110699","type":"CDM"},{"code":"61626","type":"HCPCS"}],"standard_charges":[{"gross_charge":26535.0,"discounted_cash":18574.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":21949.0,"discounted_cash":15364.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTERDISCAL PERQ ASPIR DX","code_information":[{"code":"Px00036110700","type":"CDM"},{"code":"62267","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1707.0,"discounted_cash":1194.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRAIN CEREBRO SPINAL FLUID","code_information":[{"code":"Px00036110702","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1434.0,"discounted_cash":1003.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1188.0,"discounted_cash":831.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERCUTANEOUS DISKECTOMY","code_information":[{"code":"Px00036110704","type":"CDM"},{"code":"62287","type":"HCPCS"}],"standard_charges":[{"gross_charge":12574.0,"discounted_cash":8801.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10386.0,"discounted_cash":7270.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANALYZE SPINE INFUSION PUMP W/O REPROGAM","code_information":[{"code":"Px00036110714","type":"CDM"},{"code":"62367","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM","code_information":[{"code":"Px00036110716","type":"CDM"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.0,"discounted_cash":1551.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC N BLOCK INJ FEM SINGLE","code_information":[{"code":"Px00036110717","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1474.0,"discounted_cash":1031.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC N BLOCK OTHER PERIPHERAL","code_information":[{"code":"Px00036110718","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1474.0,"discounted_cash":1031.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJ PARAVERT F JNT C/T 1 LEV","code_information":[{"code":"Px00036110723","type":"CDM"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":2096.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT C/T 1 LEV BILAT","code_information":[{"code":"Px00036110724","type":"CDM"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":2096.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1294.0,"discounted_cash":905.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2850.0,"discounted_cash":1995.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC N BLOCK LUMBAR/THORACIC","code_information":[{"code":"Px00036110733","type":"CDM"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2918.0,"discounted_cash":2042.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC N BLOCK INJ CELIAC PLEXUS","code_information":[{"code":"Px00036110734","type":"CDM"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NON HOSP DELIVERY EPISIOTOMY/VAG REPAIR CDM","code_information":[{"code":"Px00036110737","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":9942.0,"discounted_cash":6959.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRACHEOSTOMY PLANNED SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00036110749","type":"CDM"},{"code":"31600","type":"HCPCS"}],"standard_charges":[{"gross_charge":11017.0,"discounted_cash":7711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERICARDIOCENTESIS","code_information":[{"code":"Px00036110757","type":"CDM"}],"standard_charges":[{"gross_charge":2210.0,"discounted_cash":1547.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS","code_information":[{"code":"Px00036110782","type":"CDM"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":3220.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CENTRAL LINE INSERTION","code_information":[{"code":"Px00036110804","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":4095.0,"discounted_cash":2866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FACET INJ C/T SPINE THIRD LEVEL","code_information":[{"code":"Px00036110806","type":"CDM"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.0,"discounted_cash":1055.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJ MAJOR JOINT - SHOULDER/HIP/KNEE","code_information":[{"code":"Px00036110812","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.0,"discounted_cash":722.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL INDWELL TUNNEL CATHETER","code_information":[{"code":"Px00036110819","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2367.0,"discounted_cash":1656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1955.0,"discounted_cash":1368.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DCMPRN FASCT LEG ANT&/LAT&PST CMPRT","code_information":[{"code":"Px00036110893","type":"CDM"},{"code":"27602","type":"HCPCS"}],"standard_charges":[{"gross_charge":9904.0,"discounted_cash":6932.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BILIARY ENDO THRU SKIN","code_information":[{"code":"Px00036110901","type":"CDM"},{"code":"47553","type":"HCPCS"}],"standard_charges":[{"gross_charge":10002.0,"discounted_cash":7001.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PUNCTURE/CLEAR WINDPIPE","code_information":[{"code":"Px00036110907","type":"CDM"},{"code":"31612","type":"HCPCS"}],"standard_charges":[{"gross_charge":17045.0,"discounted_cash":11931.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC AIRWAYS SURGICAL PROCEDURE","code_information":[{"code":"Px00036110908","type":"CDM"},{"code":"31899","type":"HCPCS"}],"standard_charges":[{"gross_charge":3791.0,"discounted_cash":2653.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3135.0,"discounted_cash":2194.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TREAT PLEURODESIS W/AGENT","code_information":[{"code":"Px00036110912","type":"CDM"},{"code":"32560","type":"HCPCS"}],"standard_charges":[{"gross_charge":2367.0,"discounted_cash":1656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1955.0,"discounted_cash":1368.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERC RADIO FREQ ABLATION PULMONARY TUMOR","code_information":[{"code":"Px00036110913","type":"CDM"},{"code":"32998","type":"HCPCS"}],"standard_charges":[{"gross_charge":12225.0,"discounted_cash":8557.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10112.0,"discounted_cash":7078.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION THERAPY OF MULTIPLE VEINS","code_information":[{"code":"Px00036110929","type":"CDM"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DRAINAGE LYMPH NODE LESION","code_information":[{"code":"Px00036110932","type":"CDM"},{"code":"38300","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3480.0,"discounted_cash":2436.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"Px00036110934","type":"CDM"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.0,"discounted_cash":2369.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2796.0,"discounted_cash":1957.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DILATION OF SALIVARY DUCT","code_information":[{"code":"Px00036110936","type":"CDM"},{"code":"42650","type":"HCPCS"}],"standard_charges":[{"gross_charge":6040.0,"discounted_cash":4228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4990.0,"discounted_cash":3493.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC STOMACH SURGERY PROCEDURE","code_information":[{"code":"Px00036110940","type":"CDM"},{"code":"43999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2667.0,"discounted_cash":1866.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2206.0,"discounted_cash":1544.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY OF RECTUM","code_information":[{"code":"Px00036110943","type":"CDM"},{"code":"45100","type":"HCPCS"}],"standard_charges":[{"gross_charge":8783.0,"discounted_cash":6148.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12586.0,"discounted_cash":8810.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10409.0,"discounted_cash":7286.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIVER SURGERY PROCEDURE","code_information":[{"code":"Px00036110947","type":"CDM"},{"code":"47399","type":"HCPCS"}],"standard_charges":[{"gross_charge":6228.0,"discounted_cash":4359.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1356.0,"discounted_cash":949.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILE TRACT SURGERY PROCEDURE","code_information":[{"code":"Px00036110958","type":"CDM"},{"code":"47999","type":"HCPCS"}],"standard_charges":[{"gross_charge":5784.0,"discounted_cash":4048.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4782.0,"discounted_cash":3347.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PANCREAS SURGERY PROCEDURE","code_information":[{"code":"Px00036110961","type":"CDM"},{"code":"48999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2245.0,"discounted_cash":1571.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1356.0,"discounted_cash":949.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM","code_information":[{"code":"Px00036110964","type":"CDM"},{"code":"49329","type":"HCPCS"}],"standard_charges":[{"gross_charge":13948.0,"discounted_cash":9763.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11522.0,"discounted_cash":8065.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THERAPEUTIC APHERESIS PLASMA PHERESIS CDM","code_information":[{"code":"Px00036110977","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROCTOSCOPY","code_information":[{"code":"Px00036110980","type":"CDM"}],"standard_charges":[{"gross_charge":2893.0,"discounted_cash":2025.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SWAN GANZ INSERTION/PLACEMENT","code_information":[{"code":"Px00036110992","type":"CDM"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":4948.0,"discounted_cash":3463.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRACH TUBE CHANGE","code_information":[{"code":"Px00036110995","type":"CDM"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":871.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LAPAROSCOPIC ABLATION RENAL MASS","code_information":[{"code":"Px00036111009","type":"CDM"},{"code":"50542","type":"HCPCS"}],"standard_charges":[{"gross_charge":18444.0,"discounted_cash":12910.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":17523.0,"discounted_cash":12266.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERC RADIO FREQ ABLATION RENAL TUMOR","code_information":[{"code":"Px00036111013","type":"CDM"},{"code":"50592","type":"HCPCS"}],"standard_charges":[{"gross_charge":15881.0,"discounted_cash":11116.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":13120.0,"discounted_cash":9184.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERC CRYO ABLATION RENAL TUMOR","code_information":[{"code":"Px00036111014","type":"CDM"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":15881.0,"discounted_cash":11116.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":13120.0,"discounted_cash":9184.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHANGE OF URETER TUBE/STENT","code_information":[{"code":"Px00036111015","type":"CDM"},{"code":"50688","type":"HCPCS"}],"standard_charges":[{"gross_charge":6347.0,"discounted_cash":4442.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYSTOMETROGRAM W/UP","code_information":[{"code":"Px00036111017","type":"CDM"},{"code":"51727","type":"HCPCS"}],"standard_charges":[{"gross_charge":2094.0,"discounted_cash":1465.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1729.0,"discounted_cash":1210.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYSTOMETROGRAM W/VP","code_information":[{"code":"Px00036111018","type":"CDM"},{"code":"51728","type":"HCPCS"}],"standard_charges":[{"gross_charge":2094.0,"discounted_cash":1465.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1729.0,"discounted_cash":1210.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CYSTOMETROGRAM W/VP&UP","code_information":[{"code":"Px00036111019","type":"CDM"},{"code":"51729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2094.0,"discounted_cash":1465.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1729.0,"discounted_cash":1210.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTRO-UROFLOWMETRY FIRST","code_information":[{"code":"Px00036111020","type":"CDM"},{"code":"51741","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":331.0,"discounted_cash":231.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANAL/URINARY MUSCLE STUDY, NO NEEDLE","code_information":[{"code":"Px00036111021","type":"CDM"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":486.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":331.0,"discounted_cash":231.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ANAL/URINARY MUSCLE STUDY, W/ NEEDLE","code_information":[{"code":"Px00036111022","type":"CDM"},{"code":"51785","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRAABDOMINAL PRESSURE TEST","code_information":[{"code":"Px00036111023","type":"CDM"},{"code":"51797","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYSTOURETHROSCOPY, WITHFB REMOVAL SIMPLE","code_information":[{"code":"Px00036111024","type":"CDM"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":5183.0,"discounted_cash":3628.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYSTOURETHROSCOPY, W/ INSERTION OF INDWELLING URETERAL STENT","code_information":[{"code":"Px00036111025","type":"CDM"},{"code":"52332","type":"HCPCS"}],"standard_charges":[{"gross_charge":8404.0,"discounted_cash":5882.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE","code_information":[{"code":"Px00036111030","type":"CDM"},{"code":"55720","type":"HCPCS"}],"standard_charges":[{"gross_charge":9625.0,"discounted_cash":6737.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7952.0,"discounted_cash":5566.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY OF VAGINA","code_information":[{"code":"Px00036111032","type":"CDM"},{"code":"57100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.0,"discounted_cash":1409.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1537.0,"discounted_cash":1075.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DRAINAGE OF OVARIAN CYST(S), ABDOMINAL APPROACH","code_information":[{"code":"Px00036111034","type":"CDM"},{"code":"58805","type":"HCPCS"}],"standard_charges":[{"gross_charge":10698.0,"discounted_cash":7488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY OF OVARY(S)","code_information":[{"code":"Px00036111037","type":"CDM"},{"code":"58900","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":4831.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5702.0,"discounted_cash":3991.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENDOCRINE SURGERY PROCEDURE","code_information":[{"code":"Px00036111039","type":"CDM"},{"code":"60699","type":"HCPCS"}],"standard_charges":[{"gross_charge":15727.0,"discounted_cash":11008.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":13010.0,"discounted_cash":9107.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION INTO BRAIN CANAL FOR DIAGNOSIS/TREATMENT","code_information":[{"code":"Px00036111040","type":"CDM"},{"code":"61026","type":"HCPCS"}],"standard_charges":[{"gross_charge":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE BRAIN CANAL FLUID","code_information":[{"code":"Px00036111041","type":"CDM"},{"code":"61050","type":"HCPCS"}],"standard_charges":[{"gross_charge":2715.0,"discounted_cash":1900.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2245.0,"discounted_cash":1571.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRACRANIAL ANGIOPLASTY","code_information":[{"code":"Px00036111048","type":"CDM"},{"code":"61630","type":"HCPCS"}],"standard_charges":[{"gross_charge":6337.0,"discounted_cash":4435.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRACRANIAL ANGIOPLASTY W/STENT","code_information":[{"code":"Px00036111049","type":"CDM"},{"code":"61635","type":"HCPCS"}],"standard_charges":[{"gross_charge":7240.0,"discounted_cash":5068.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DILATE INTRACRANIAL VASOSPASM INITIAL","code_information":[{"code":"Px00036111050","type":"CDM"},{"code":"61640","type":"HCPCS"}],"standard_charges":[{"gross_charge":6337.0,"discounted_cash":4435.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ BALO DILA IC VSPSM EA VSL SM VASC TER","code_information":[{"code":"Px00036111051","type":"CDM"},{"code":"61641","type":"HCPCS"}],"standard_charges":[{"gross_charge":6337.0,"discounted_cash":4435.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ BALO DILA IC VSPSM EA VSL DIFF VASC TER","code_information":[{"code":"Px00036111052","type":"CDM"},{"code":"61642","type":"HCPCS"}],"standard_charges":[{"gross_charge":6337.0,"discounted_cash":4435.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPLACE/REVISE BRAIN SHUNT","code_information":[{"code":"Px00036111054","type":"CDM"},{"code":"62230","type":"HCPCS"}],"standard_charges":[{"gross_charge":20496.0,"discounted_cash":14347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY SPINAL CORD","code_information":[{"code":"Px00036111056","type":"CDM"},{"code":"62269","type":"HCPCS"}],"standard_charges":[{"gross_charge":3100.0,"discounted_cash":2170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2564.0,"discounted_cash":1794.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN CDM","code_information":[{"code":"Px00036111069","type":"CDM"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2882.0,"discounted_cash":2017.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX CDM","code_information":[{"code":"Px00036111077","type":"CDM"},{"code":"61020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3325.0,"discounted_cash":2327.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE CDM","code_information":[{"code":"Px00036111081","type":"CDM"},{"code":"61210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":977.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DELIVERY PLACENTA SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00036111084","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":9429.0,"discounted_cash":6600.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE BLOCK STELLATE GANGLION","code_information":[{"code":"Px00036111088","type":"CDM"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2950.0,"discounted_cash":2065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION TREATMENT OF INTERCOSTAL NERVE","code_information":[{"code":"Px00036111092","type":"CDM"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":3084.0,"discounted_cash":2158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE CDM","code_information":[{"code":"Px00036111093","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2311.0,"discounted_cash":1617.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION TREATMENT OF NERVE CELIAC PLEXUS","code_information":[{"code":"Px00036111095","type":"CDM"},{"code":"64680","type":"HCPCS"}],"standard_charges":[{"gross_charge":7970.0,"discounted_cash":5579.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6414.0,"discounted_cash":4489.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BILIARY ENDOSCOPY THRU SKIN, W/ STONE REMOVAL","code_information":[{"code":"Px00036111097","type":"CDM"},{"code":"47554","type":"HCPCS"}],"standard_charges":[{"gross_charge":15898.0,"discounted_cash":11128.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE CDM","code_information":[{"code":"Px00036111102","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INS TEMP INDWELLING BLADDER CATH COMPLICATED CDM","code_information":[{"code":"Px00036111105","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5941.0,"discounted_cash":4158.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1538.0,"discounted_cash":1076.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3173.0,"discounted_cash":2221.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2949.0,"discounted_cash":2064.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3173.0,"discounted_cash":2221.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11133.0,"discounted_cash":7793.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16804.0,"discounted_cash":11762.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24615.0,"discounted_cash":17230.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24615.0,"discounted_cash":17230.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19372.0,"discounted_cash":13560.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19372.0,"discounted_cash":13560.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13131.0,"discounted_cash":9191.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13131.0,"discounted_cash":9191.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15064.0,"discounted_cash":10544.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9666.0,"discounted_cash":6766.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9666.0,"discounted_cash":6766.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9969.0,"discounted_cash":6978.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9969.0,"discounted_cash":6978.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH","code_information":[{"code":"Px00036111142","type":"CDM"},{"code":"33361","type":"HCPCS"}],"standard_charges":[{"gross_charge":26221.0,"discounted_cash":18354.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1879.0,"discounted_cash":1315.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS","code_information":[{"code":"Px00036111151","type":"CDM"},{"code":"33991","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.0,"discounted_cash":1374.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION","code_information":[{"code":"Px00036111152","type":"CDM"},{"code":"33992","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":1302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1860.0,"discounted_cash":1302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE BLOCK INJ PUDENDAL","code_information":[{"code":"Px00036111164","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3073.0,"discounted_cash":2151.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABLAT RF BONE TUMOR W CT GUID","code_information":[{"code":"Px00036111165","type":"CDM"},{"code":"20999","type":"HCPCS"}],"standard_charges":[{"gross_charge":6497.0,"discounted_cash":4547.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PM NEW/REPL PER ART/VENT","code_information":[{"code":"Px00036111166","type":"CDM"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":23214.0,"discounted_cash":16249.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RECALL REPL PERM PAC SNG","code_information":[{"code":"Px00036111167","type":"CDM"},{"code":"33212","type":"HCPCS"}],"standard_charges":[{"gross_charge":33717.0,"discounted_cash":23601.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RECALL REM PERM PACER","code_information":[{"code":"Px00036111168","type":"CDM"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":6486.0,"discounted_cash":4540.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART BIL","code_information":[{"code":"Px00036111171","type":"CDM"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":16804.0,"discounted_cash":11762.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ILIAC PTA 1ST/U BIL CV","code_information":[{"code":"Px00036111173","type":"CDM"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":20009.0,"discounted_cash":14006.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SALIVARY SURG PROC UNLISTED","code_information":[{"code":"Px00036111174","type":"CDM"},{"code":"42699","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UNLISTED SINUS PROCEDURE","code_information":[{"code":"Px00036111179","type":"CDM"},{"code":"31299","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION PICC W/O IMG GUIDANCE/YOUNGER THAN 5 YRS","code_information":[{"code":"Px00036111180","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.0,"discounted_cash":779.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRO WINDPIPE WIRE/TUBE","code_information":[{"code":"Px00036111181","type":"CDM"},{"code":"31730","type":"HCPCS"}],"standard_charges":[{"gross_charge":4976.0,"discounted_cash":3483.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":620.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION STEREO","code_information":[{"code":"Px00036111183","type":"CDM"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":2595.0,"discounted_cash":1816.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION STEREO","code_information":[{"code":"Px00036111184","type":"CDM"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2595.0,"discounted_cash":1816.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2595.0,"discounted_cash":1816.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHEMODENERV SALIV GLANDS BIL","code_information":[{"code":"Px00036111203","type":"CDM"},{"code":"64611","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2529.0,"discounted_cash":1770.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECT/TREAT EYE SOCKET","code_information":[{"code":"Px00036111212","type":"CDM"},{"code":"67500","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1068.0,"discounted_cash":747.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2865.0,"discounted_cash":2005.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17189.0,"discounted_cash":12032.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"Px00036111222","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":11687.0,"discounted_cash":8180.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"Px00036111223","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":11687.0,"discounted_cash":8180.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"Px00036111224","type":"CDM"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":11687.0,"discounted_cash":8180.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":29228.0,"discounted_cash":20459.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":29228.0,"discounted_cash":20459.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":28392.0,"discounted_cash":19874.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INS/REP SUBQ DEFIBRILLATOR INCLUDING EVAL WHEN PERFORMED","code_information":[{"code":"Px00036111228","type":"CDM"},{"code":"33270","type":"HCPCS"}],"standard_charges":[{"gross_charge":132557.0,"discounted_cash":92789.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSJ SUBQ IMPLTBL DFB ELCTRD","code_information":[{"code":"Px00036111229","type":"CDM"},{"code":"33271","type":"HCPCS"}],"standard_charges":[{"gross_charge":28155.0,"discounted_cash":19708.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RMVL OF SUBQ DEFIBRILLATOR","code_information":[{"code":"Px00036111230","type":"CDM"},{"code":"33272","type":"HCPCS"}],"standard_charges":[{"gross_charge":10097.0,"discounted_cash":7067.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPOS PREV IMPLTBL SUBQ DFB","code_information":[{"code":"Px00036111231","type":"CDM"},{"code":"33273","type":"HCPCS"}],"standard_charges":[{"gross_charge":10097.0,"discounted_cash":7067.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ ABLTJ LVR CRYOABLATION","code_information":[{"code":"Px00036111233","type":"CDM"},{"code":"47383","type":"HCPCS"}],"standard_charges":[{"gross_charge":18394.0,"discounted_cash":12875.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2805.0,"discounted_cash":1963.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2805.0,"discounted_cash":1963.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2805.0,"discounted_cash":1963.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2805.0,"discounted_cash":1963.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRANSV ABD PLANE/RECTUS SHEATH BLOCK UNIL BY INJECTION","code_information":[{"code":"Px00036111238","type":"CDM"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRANSV ABD PLANE BLOCK UNI BY INFUSION","code_information":[{"code":"Px00036111239","type":"CDM"},{"code":"64487","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRANSV ABD PLANE/RECTUS SHEATH BLOCK BI INJECTION","code_information":[{"code":"Px00036111240","type":"CDM"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":670.0,"discounted_cash":469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":670.0,"discounted_cash":469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY OF TESTIS","code_information":[{"code":"Px00036111249","type":"CDM"},{"code":"54500","type":"HCPCS"}],"standard_charges":[{"gross_charge":8771.0,"discounted_cash":6139.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","code_information":[{"code":"Px00036111250","type":"CDM"},{"code":"27605","type":"HCPCS"}],"standard_charges":[{"gross_charge":7968.0,"discounted_cash":5577.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEW REPAIR ELBOW PERCUTANEOUS","code_information":[{"code":"Px00036111251","type":"CDM"},{"code":"24357","type":"HCPCS"}],"standard_charges":[{"gross_charge":11692.0,"discounted_cash":8184.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INCISION OF THIGH TENDON","code_information":[{"code":"Px00036111252","type":"CDM"},{"code":"27306","type":"HCPCS"}],"standard_charges":[{"gross_charge":7591.0,"discounted_cash":5313.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INCISION OF FOOT FASCIA","code_information":[{"code":"Px00036111253","type":"CDM"},{"code":"28008","type":"HCPCS"}],"standard_charges":[{"gross_charge":7968.0,"discounted_cash":5577.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROBE NL DUCT W/BALLOON","code_information":[{"code":"Px00036111255","type":"CDM"},{"code":"68816","type":"HCPCS"}],"standard_charges":[{"gross_charge":5331.0,"discounted_cash":3731.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GENITAL SURGERY PROCEDURE, FEMALE UNLISTED","code_information":[{"code":"Px00036111269","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REVISION OF PERITONEAL VENOUS SHUNT","code_information":[{"code":"Px00036111276","type":"CDM"},{"code":"49426","type":"HCPCS"}],"standard_charges":[{"gross_charge":12960.0,"discounted_cash":9072.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD ILIOINGUINAL-ILIOHYPOGASTRI IH NERVES","code_information":[{"code":"Px00036111279","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.0,"discounted_cash":1525.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY FOREARM SOFT TISSUES SUPERFICIAL","code_information":[{"code":"Px00036112002","type":"CDM"},{"code":"25065","type":"HCPCS"}],"standard_charges":[{"gross_charge":4705.0,"discounted_cash":3293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY FOREARM SOFT TISSUES-DEEP","code_information":[{"code":"Px00036112003","type":"CDM"},{"code":"25066","type":"HCPCS"}],"standard_charges":[{"gross_charge":8679.0,"discounted_cash":6075.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7169.0,"discounted_cash":5018.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00036112004","type":"CDM"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY OF SOFT TISSUES SUPERFICIAL","code_information":[{"code":"Px00036112005","type":"CDM"},{"code":"27040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2208.0,"discounted_cash":1545.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY OF SOFT TISSUES DEEP","code_information":[{"code":"Px00036112006","type":"CDM"},{"code":"27041","type":"HCPCS"}],"standard_charges":[{"gross_charge":5592.0,"discounted_cash":3914.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3153.0,"discounted_cash":2207.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PELVIS/HIP JOINT SURGERY","code_information":[{"code":"Px00036112010","type":"CDM"},{"code":"27299","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":360.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY THIGH SOFT TISSUES","code_information":[{"code":"Px00036112011","type":"CDM"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":5410.0,"discounted_cash":3787.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP","code_information":[{"code":"Px00036112012","type":"CDM"},{"code":"27324","type":"HCPCS"}],"standard_charges":[{"gross_charge":8679.0,"discounted_cash":6075.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7169.0,"discounted_cash":5018.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REMOVE FEMUR LESION","code_information":[{"code":"Px00036112013","type":"CDM"},{"code":"27355","type":"HCPCS"}],"standard_charges":[{"gross_charge":11666.0,"discounted_cash":8166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9639.0,"discounted_cash":6747.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY LOWER LEG SOFT TISSUE","code_information":[{"code":"Px00036112015","type":"CDM"},{"code":"27613","type":"HCPCS"}],"standard_charges":[{"gross_charge":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEG LOWER ST BIOPSY-DEEP","code_information":[{"code":"Px00036112016","type":"CDM"},{"code":"27614","type":"HCPCS"}],"standard_charges":[{"gross_charge":8679.0,"discounted_cash":6075.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7169.0,"discounted_cash":5018.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION PROC FOR ANKLE ARTHROGRAM","code_information":[{"code":"Px00036112017","type":"CDM"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVE/INSERT DRUG IMPLANT","code_information":[{"code":"Px00036112055","type":"CDM"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":1450.0,"discounted_cash":1015.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ATTEMPT PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00036112059","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":1117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CHANGE STENT VIA TRANSURETH","code_information":[{"code":"Px00036112064","type":"CDM"},{"code":"50385","type":"HCPCS"}],"standard_charges":[{"gross_charge":7416.0,"discounted_cash":5191.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"Px00036113015","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2437.0,"discounted_cash":1705.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":359.0,"discounted_cash":251.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":634.0,"discounted_cash":443.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CP REM AND REPL PACER GEN DUAL","code_information":[{"code":"Px00036113068","type":"CDM"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":40128.0,"discounted_cash":28089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9666.0,"discounted_cash":6766.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CP INS MULT LEAD PACER GEN ONLY","code_information":[{"code":"Px00036114001","type":"CDM"},{"code":"33221","type":"HCPCS"}],"standard_charges":[{"gross_charge":44224.0,"discounted_cash":30956.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":23493.0,"discounted_cash":16445.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CP REM AND REPL PACER GEN SIN","code_information":[{"code":"Px00036114002","type":"CDM"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":21327.0,"discounted_cash":14928.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9259.0,"discounted_cash":6481.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CP REM AND REPL PACER GEN MULT","code_information":[{"code":"Px00036114003","type":"CDM"},{"code":"33229","type":"HCPCS"}],"standard_charges":[{"gross_charge":23391.0,"discounted_cash":16373.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9666.0,"discounted_cash":6766.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPOSITION IVC FILTER COMP","code_information":[{"code":"Px00036114007","type":"CDM"},{"code":"37192","type":"HCPCS"}],"standard_charges":[{"gross_charge":11738.0,"discounted_cash":8216.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6408.0,"discounted_cash":4485.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REPAIR TCAT MITRAL VALVE PERC APPRCH ADDL PROSTHESIS","code_information":[{"code":"Px00036114008","type":"CDM"},{"code":"33419","type":"HCPCS"}],"standard_charges":[{"gross_charge":19620.0,"discounted_cash":13734.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19620.0,"discounted_cash":13734.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL DUCT GLBLDR CALCULI","code_information":[{"code":"Px00036114020","type":"CDM"},{"code":"47544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3460.0,"discounted_cash":2422.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGUS SURGERY PROCEDURE UNLISTED","code_information":[{"code":"Px00036114025","type":"CDM"},{"code":"43499","type":"HCPCS"}],"standard_charges":[{"gross_charge":3448.0,"discounted_cash":2413.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UNLISTED LAPAROSCOPY PROCEDURE BLADDER","code_information":[{"code":"Px00036114026","type":"CDM"},{"code":"51999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18507.0,"discounted_cash":12954.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABLAT EXTREM MECHAN 1ST","code_information":[{"code":"Px00036114029","type":"CDM"},{"code":"36473","type":"HCPCS"}],"standard_charges":[{"gross_charge":10502.0,"discounted_cash":7351.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABLAT EXTREM MECHAN ADDL","code_information":[{"code":"Px00036114030","type":"CDM"},{"code":"36474","type":"HCPCS"}],"standard_charges":[{"gross_charge":5253.0,"discounted_cash":3677.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2919.0,"discounted_cash":2043.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20561.0,"discounted_cash":14392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":41556.0,"discounted_cash":29089.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THROMBECT DIALYSIS CIRCUIT","code_information":[{"code":"Px00036114036","type":"CDM"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":20561.0,"discounted_cash":14392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THROMBECT DIALY CIRCUIT W/BALN","code_information":[{"code":"Px00036114037","type":"CDM"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":20561.0,"discounted_cash":14392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":62984.0,"discounted_cash":44088.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOPLASTY BALLN DIALY CIRC","code_information":[{"code":"Px00036114039","type":"CDM"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":13740.0,"discounted_cash":9618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6872.0,"discounted_cash":4810.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EMBOLIZATION/OCCLU DIALY CIRC","code_information":[{"code":"Px00036114041","type":"CDM"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":6872.0,"discounted_cash":4810.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOPLAST BALLN TRNSL 1ST ART","code_information":[{"code":"Px00036114042","type":"CDM"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":21166.0,"discounted_cash":14816.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL ADDL ART","code_information":[{"code":"Px00036114043","type":"CDM"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":30841.0,"discounted_cash":21588.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL 1ST VEIN","code_information":[{"code":"Px00036114044","type":"CDM"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":20561.0,"discounted_cash":14392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNS ADDL VEIN","code_information":[{"code":"Px00036114045","type":"CDM"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":20561.0,"discounted_cash":14392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2297.0,"discounted_cash":1607.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2365.0,"discounted_cash":1655.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2894.0,"discounted_cash":2025.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2894.0,"discounted_cash":2025.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJ INTERLAMINAR LMBR/SAC W/O IMG","code_information":[{"code":"Px00036114051","type":"CDM"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":2894.0,"discounted_cash":2025.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJ PLACE CATH EPI CONT INF OR  BOLUS L/S W/IMG","code_information":[{"code":"Px00036114052","type":"CDM"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":2894.0,"discounted_cash":2025.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOSC DCMP 1 SPACE LUM","code_information":[{"code":"Px00036114053","type":"CDM"},{"code":"62380","type":"HCPCS"}],"standard_charges":[{"gross_charge":23227.0,"discounted_cash":16258.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2297.0,"discounted_cash":1607.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2297.0,"discounted_cash":1607.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC JOINT ASPIRATION","code_information":[{"code":"Px00036119046","type":"CDM"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":870.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2999.0,"discounted_cash":2099.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMPLANT TCAT PULM VLV PERQ","code_information":[{"code":"Px00036119075","type":"CDM"},{"code":"33477","type":"HCPCS"}],"standard_charges":[{"gross_charge":10659.0,"discounted_cash":7461.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRVASC US NONCORONARY 1ST","code_information":[{"code":"Px00036119076","type":"CDM"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":9052.0,"discounted_cash":6336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRVASC US NONCORONARY ADDL","code_information":[{"code":"Px00036119077","type":"CDM"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":7980.0,"discounted_cash":5586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS","code_information":[{"code":"Px00036119078","type":"CDM"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, NEW ACCESS","code_information":[{"code":"Px00036119079","type":"CDM"},{"code":"47532","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":704.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, EXTERNAL","code_information":[{"code":"Px00036119080","type":"CDM"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":6719.0,"discounted_cash":4703.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14205.0,"discounted_cash":9943.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONVERSION EXT BIL DRG CATH","code_information":[{"code":"Px00036119082","type":"CDM"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":4600.0,"discounted_cash":3220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EXCHANGE BILIARY DRG CATH","code_information":[{"code":"Px00036119083","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":4600.0,"discounted_cash":3220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL BILIARY DRG CATH","code_information":[{"code":"Px00036119084","type":"CDM"},{"code":"47537","type":"HCPCS"}],"standard_charges":[{"gross_charge":3208.0,"discounted_cash":2245.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ PLMT BILE DUCT STENT, EXISTING ACCESS","code_information":[{"code":"Px00036119085","type":"CDM"},{"code":"47538","type":"HCPCS"}],"standard_charges":[{"gross_charge":3677.0,"discounted_cash":2573.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4372.0,"discounted_cash":3060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ PLMT BILE DUCT STENT, NEW ACCESS INT-EXT","code_information":[{"code":"Px00036119087","type":"CDM"},{"code":"47540","type":"HCPCS"}],"standard_charges":[{"gross_charge":4852.0,"discounted_cash":3396.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW CDM","code_information":[{"code":"Px00036119088","type":"CDM"},{"code":"47541","type":"HCPCS"}],"standard_charges":[{"gross_charge":3818.0,"discounted_cash":2672.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DILATE BILIARY DUCT/AMPULLA. EA DUCT","code_information":[{"code":"Px00036119089","type":"CDM"},{"code":"47542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1968.0,"discounted_cash":1377.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOLUMINAL BX BILIARY TREE, SINGL/MLTP","code_information":[{"code":"Px00036119090","type":"CDM"},{"code":"47543","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":925.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SCLEROTX FLUID COLLECTION","code_information":[{"code":"Px00036119091","type":"CDM"},{"code":"49185","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.0,"discounted_cash":1400.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":415.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":415.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"Px00036119094","type":"CDM"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":6013.0,"discounted_cash":4209.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLMT NEPHROURETERAL CATHETER, NEW ACCESS","code_information":[{"code":"Px00036119095","type":"CDM"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":5198.0,"discounted_cash":3638.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CONVERT NEPHROSTOMY CATHETER, PRE-EXISTING TRACT","code_information":[{"code":"Px00036119096","type":"CDM"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":5198.0,"discounted_cash":3638.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EXCHANGE NEPHROSTOMY CATH","code_information":[{"code":"Px00036119097","type":"CDM"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":4544.0,"discounted_cash":3180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOLUMINAL BX URTR RNL PLVS","code_information":[{"code":"Px00036119098","type":"CDM"},{"code":"50606","type":"HCPCS"}],"standard_charges":[{"gross_charge":8475.0,"discounted_cash":5932.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8610.0,"discounted_cash":6027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLMT URETERAL STENT PRQ, NEW ACCESS","code_information":[{"code":"Px00036119100","type":"CDM"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":8610.0,"discounted_cash":6027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLMT URETERAL STENT PRQ, NEW ACCESS SEP CATH","code_information":[{"code":"Px00036119101","type":"CDM"},{"code":"50695","type":"HCPCS"}],"standard_charges":[{"gross_charge":8610.0,"discounted_cash":6027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC URETERAL EMBOLIZATION/OCCL","code_information":[{"code":"Px00036119102","type":"CDM"},{"code":"50705","type":"HCPCS"}],"standard_charges":[{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BALLOON DILATE URTRL STRIX","code_information":[{"code":"Px00036119103","type":"CDM"},{"code":"50706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3125.0,"discounted_cash":2187.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ ART M-THROMBECT &/NFS","code_information":[{"code":"Px00036119104","type":"CDM"},{"code":"61645","type":"HCPCS"}],"standard_charges":[{"gross_charge":14897.0,"discounted_cash":10427.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC PRLNG ADMN RX AGNT 1ST","code_information":[{"code":"Px00036119105","type":"CDM"},{"code":"61650","type":"HCPCS"}],"standard_charges":[{"gross_charge":6531.0,"discounted_cash":4571.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC PRLNG ADMN RX AGNT ADD","code_information":[{"code":"Px00036119106","type":"CDM"},{"code":"61651","type":"HCPCS"}],"standard_charges":[{"gross_charge":3267.0,"discounted_cash":2286.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PVB THORACIC SINGLE INJ SITE","code_information":[{"code":"Px00036119107","type":"CDM"},{"code":"64461","type":"HCPCS"}],"standard_charges":[{"gross_charge":3073.0,"discounted_cash":2151.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PVB THORACIC 2ND+ INJ SITE","code_information":[{"code":"Px00036119108","type":"CDM"},{"code":"64462","type":"HCPCS"}],"standard_charges":[{"gross_charge":1538.0,"discounted_cash":1076.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PVB THORACIC CONT CATHETER INFUSION W/IMG GID","code_information":[{"code":"Px00036119109","type":"CDM"},{"code":"64463","type":"HCPCS"}],"standard_charges":[{"gross_charge":3277.0,"discounted_cash":2293.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ","code_information":[{"code":"Px00036133333","type":"CDM"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","code_information":[{"code":"Px00036166666","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":342.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HARVEST AUTO STEM CELLS CDM","code_information":[{"code":"Px00036200001","type":"CDM"},{"code":"38206","type":"HCPCS"}],"standard_charges":[{"gross_charge":12656.0,"discounted_cash":8859.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRYOPRESERVE STEM CELLS CDM","code_information":[{"code":"Px00036200002","type":"CDM"},{"code":"38207","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":1155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR CDM","code_information":[{"code":"Px00036200003","type":"CDM"},{"code":"38208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1435.0,"discounted_cash":1004.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":706.0,"discounted_cash":494.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":706.0,"discounted_cash":494.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":706.0,"discounted_cash":494.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":706.0,"discounted_cash":494.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT","code_information":[{"code":"Px00039010002","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED CPDA","code_information":[{"code":"Px00039010003","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":355.0,"discounted_cash":248.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THERAPEUTIC APHERESIS PLASMA PHERESIS LAB","code_information":[{"code":"Px00039010004","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":3962.0,"discounted_cash":2773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":421.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":101.0,"discounted_cash":70.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET PHERESIS SNGL DNR EA","code_information":[{"code":"Px00039010006","type":"CDM"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.39,"discounted_cash":833.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PHOTOPHERESIS EXTRACORPOREAL","code_information":[{"code":"Px00039010007","type":"CDM"},{"code":"36522","type":"HCPCS"}],"standard_charges":[{"gross_charge":13465.0,"discounted_cash":9425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10645.0,"discounted_cash":7451.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC WHOLE BLOOD FOR TRANSFUSION","code_information":[{"code":"Px00039010010","type":"CDM"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1548.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":853.0,"discounted_cash":597.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FRESH FROZEN PLASMA PEDS EA UNIT FRZ W/IN 8 HR","code_information":[{"code":"Px00039010011","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":101.0,"discounted_cash":70.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AUTOLOGOUS WHOLE BLOOD FOR TRANSFUSION","code_information":[{"code":"Px00039010012","type":"CDM"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.0,"discounted_cash":858.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":249.0,"discounted_cash":174.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD SPLIT UNIT RBC","code_information":[{"code":"Px00039010013","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PEDIATRIC WHOLE BLOOD","code_information":[{"code":"Px00039010014","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED","code_information":[{"code":"Px00039010015","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":243.0,"discounted_cash":170.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUCED PED PACK","code_information":[{"code":"Px00039010016","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":243.0,"discounted_cash":170.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":574.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":101.0,"discounted_cash":70.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELETS EACH UNIT","code_information":[{"code":"Px00039010018","type":"CDM"},{"code":"P9019","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":272.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":150.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET RICH PLASMA UNIT","code_information":[{"code":"Px00039010019","type":"CDM"},{"code":"P9020","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":508.0,"discounted_cash":355.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RED BLOOD CELLS SPLIT EACH UNIT","code_information":[{"code":"Px00039010020","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AUTOLOGOUS RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010021","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010022","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RED BLOOD CELLS UNIT PEDI-PACK","code_information":[{"code":"Px00039010023","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC WASHED RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010024","type":"CDM"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":369.0,"discounted_cash":258.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMAPHERESIS FFP 600ML","code_information":[{"code":"Px00039010025","type":"CDM"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":510.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMAPHERESIS FFP 300ML","code_information":[{"code":"Px00039010026","type":"CDM"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":92.0,"discounted_cash":64.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELETS LEUKOCYTES REDUCED","code_information":[{"code":"Px00039010027","type":"CDM"},{"code":"P9031","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELETS IRRADIATED","code_information":[{"code":"Px00039010028","type":"CDM"},{"code":"P9032","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":536.0,"discounted_cash":375.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELETS LEUKOREDUCED IRRAD","code_information":[{"code":"Px00039010029","type":"CDM"},{"code":"P9033","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.17,"discounted_cash":431.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLATELET PHERESIS","code_information":[{"code":"Px00039010030","type":"CDM"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.39,"discounted_cash":833.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCED","code_information":[{"code":"Px00039010031","type":"CDM"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1772.0,"discounted_cash":1240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":636.0,"discounted_cash":445.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET PHERESIS IRRADIATED","code_information":[{"code":"Px00039010032","type":"CDM"},{"code":"P9036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1859.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1859.0,"discounted_cash":1301.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET PHERESIS LEUKOREDU IRRAD","code_information":[{"code":"Px00039010033","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1548.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":853.0,"discounted_cash":597.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC IRRADIATED","code_information":[{"code":"Px00039010034","type":"CDM"},{"code":"P9038","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.66,"discounted_cash":313.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RBC DEGLYCEROLIZED","code_information":[{"code":"Px00039010035","type":"CDM"},{"code":"P9039","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.0,"discounted_cash":878.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":484.0,"discounted_cash":338.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYOPRECIPITATE REDUCED PLASMA","code_information":[{"code":"Px00039010036","type":"CDM"},{"code":"P9044","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":110.0,"discounted_cash":77.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GRANULOCYTES PHERESIS UNIT","code_information":[{"code":"Px00039010037","type":"CDM"},{"code":"P9050","type":"HCPCS"}],"standard_charges":[{"gross_charge":5403.0,"discounted_cash":3782.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5403.0,"discounted_cash":3782.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUC CMV NEG EA UNIT","code_information":[{"code":"Px00039010038","type":"CDM"},{"code":"P9051","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":217.0,"discounted_cash":151.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLT PHERESIS HLA MATCHED LEUK REDUCED","code_information":[{"code":"Px00039010039","type":"CDM"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2582.0,"discounted_cash":1807.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":995.0,"discounted_cash":696.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLT PHERESIS LR IRR CMV NEG","code_information":[{"code":"Px00039010040","type":"CDM"},{"code":"P9053","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1619.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":892.0,"discounted_cash":624.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBCS LEUKO REDCD FRZN DEGLYCEROL WASHED EA UNIT","code_information":[{"code":"Px00039010041","type":"CDM"},{"code":"P9054","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.32,"discounted_cash":509.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLT PHERESIS LR CMV NEG","code_information":[{"code":"Px00039010042","type":"CDM"},{"code":"P9055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1954.0,"discounted_cash":1367.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":551.0,"discounted_cash":385.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC WASHED LEUKOREDUC IRRAD","code_information":[{"code":"Px00039010043","type":"CDM"},{"code":"P9057","type":"HCPCS"}],"standard_charges":[{"gross_charge":2829.0,"discounted_cash":1980.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":959.0,"discounted_cash":671.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":370.0,"discounted_cash":259.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FRESH FROZEN PLASMA FRZ BETWEEN 8-24HOUR","code_information":[{"code":"Px00039010045","type":"CDM"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FRESH FROZEN PLASMA DONOR RETESTED","code_information":[{"code":"Px00039010046","type":"CDM"},{"code":"P9060","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":187.0,"discounted_cash":130.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FRESH FROZEN PLASMA DIRECTED EA UNIT","code_information":[{"code":"Px00039010047","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":101.0,"discounted_cash":70.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET APH LEUKO IRR EA UNIT","code_information":[{"code":"Px00039010048","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1548.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":853.0,"discounted_cash":597.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRYOPRECIPITATE AUTO EACH UNIT","code_information":[{"code":"Px00039010049","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":746.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FRESH FROZEN PLASMA AUTO EA UNIT FRZ W/IN 8 HR","code_information":[{"code":"Px00039010050","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":101.0,"discounted_cash":70.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RED BLOOD CELLS UNIT DIRECTED DONOR","code_information":[{"code":"Px00039010051","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELET PHERESIS MINI EA UNT","code_information":[{"code":"Px00039010052","type":"CDM"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.39,"discounted_cash":833.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLATELET PHERESIS DIRECTED","code_information":[{"code":"Px00039010053","type":"CDM"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.39,"discounted_cash":833.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT POOLED","code_information":[{"code":"Px00039010054","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":746.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":84.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED","code_information":[{"code":"Px00039010055","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":355.0,"discounted_cash":248.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED PEDIPAK","code_information":[{"code":"Px00039010056","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":355.0,"discounted_cash":248.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED PEDIPACK 8 ASSIGNED","code_information":[{"code":"Px00039010057","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":355.0,"discounted_cash":248.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUCED DIRECTED","code_information":[{"code":"Px00039010059","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":243.0,"discounted_cash":170.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELETS PHERESIS PATH REDU","code_information":[{"code":"Px00039010064","type":"CDM"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1548.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":853.0,"discounted_cash":597.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELETS LEUKOCYTES REDUCED","code_information":[{"code":"Px00039010101","type":"CDM"},{"code":"P9031","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLATELETS LEUKOREDUCED IRRAD","code_information":[{"code":"Px00039010102","type":"CDM"},{"code":"P9033","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.17,"discounted_cash":431.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LIQUID PLASMA","code_information":[{"code":"Px00039010103","type":"CDM"},{"code":"P9031","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":151.0,"discounted_cash":105.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LIQUID PLASMA IRRADIATED","code_information":[{"code":"Px00039010104","type":"CDM"},{"code":"P9033","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.17,"discounted_cash":431.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD TRANSFUSION EA UNIT CDM","code_information":[{"code":"Px00039110001","type":"CDM"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":968.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1145.0,"discounted_cash":801.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXCHNG TRANSFUSION BLOOD NEWBORN CDM","code_information":[{"code":"Px00039110224","type":"CDM"},{"code":"36450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.0,"discounted_cash":1096.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD SPLIT UNIT PLASMA","code_information":[{"code":"Px00039910001","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BLOOD SPLIT UNIT PLATELET PHERESIS","code_information":[{"code":"Px00039910002","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED AUTO","code_information":[{"code":"Px00039910003","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":243.0,"discounted_cash":170.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC IRRADIATED WASHED","code_information":[{"code":"Px00039910004","type":"CDM"},{"code":"P9038","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.66,"discounted_cash":313.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED DIRECTED DONOR","code_information":[{"code":"Px00039910005","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":355.0,"discounted_cash":248.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED WASHED","code_information":[{"code":"Px00039910006","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":355.0,"discounted_cash":248.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MAMMO DIAG BIL W CAD","code_information":[{"code":"Px00040110004","type":"CDM"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":229.0,"discounted_cash":160.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUAN US TISS CHARAC I&R W/O DX US SAME ANAT CDM","code_information":[{"code":"Px00040200001","type":"CDM"},{"code":"0689T","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC QUANTITATIVE US TISS CHARAC I&R W/DX US SM ANAT CDM","code_information":[{"code":"Px00040200002","type":"CDM"},{"code":"0690T","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO EXAM OF HEAD","code_information":[{"code":"Px00040210001","type":"CDM"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.0,"discounted_cash":1055.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OPHTH US B W/NON-QUANT A","code_information":[{"code":"Px00040210003","type":"CDM"},{"code":"76512","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US EXAM CHEST","code_information":[{"code":"Px00040210005","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.0,"discounted_cash":982.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US EXAM ABDOMEN COMPLETE","code_information":[{"code":"Px00040210008","type":"CDM"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2334.0,"discounted_cash":1633.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US EXAM PELVIC LIMITED","code_information":[{"code":"Px00040210009","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":910.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US RETROPERITONEAL COMPLETE","code_information":[{"code":"Px00040210010","type":"CDM"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2120.0,"discounted_cash":1484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US RETROPERITONEAL LIMITED","code_information":[{"code":"Px00040210011","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US EXAM KIDNEY TRANSPLANT W/DOPPLER","code_information":[{"code":"Px00040210012","type":"CDM"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1315.0,"discounted_cash":920.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US SPINAL CANAL","code_information":[{"code":"Px00040210013","type":"CDM"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2334.0,"discounted_cash":1633.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1962.0,"discounted_cash":1373.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2199.0,"discounted_cash":1539.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US OB AFTER 1ST TRIMESTER ADD FETUS","code_information":[{"code":"Px00040210017","type":"CDM"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2074.0,"discounted_cash":1451.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US OB DETAILED SINGLE FETUS CDM","code_information":[{"code":"Px00040210018","type":"CDM"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":3550.0,"discounted_cash":2485.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US OB DETAILED ADDL FETUS CDM","code_information":[{"code":"Px00040210019","type":"CDM"},{"code":"76812","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1301.0,"discounted_cash":910.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US OB NUCHAL MEASUREMENT ADD GEST CDM","code_information":[{"code":"Px00040210021","type":"CDM"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US OB FOLLOW-UP PER FETUS CDM","code_information":[{"code":"Px00040210023","type":"CDM"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"discounted_cash":1007.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US OB TRANSVAGINAL CDM","code_information":[{"code":"Px00040210024","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1593.0,"discounted_cash":1115.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/NST CDM","code_information":[{"code":"Px00040210025","type":"CDM"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1332.0,"discounted_cash":932.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US MIDDLE CEREBRAL ARTERY ECHO CDM","code_information":[{"code":"Px00040210028","type":"CDM"},{"code":"76821","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":264.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ECHO EXAM OF FETAL HEART CDM","code_information":[{"code":"Px00040210029","type":"CDM"},{"code":"76825","type":"HCPCS"}],"standard_charges":[{"gross_charge":3112.0,"discounted_cash":2178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":546.0,"discounted_cash":382.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1355.0,"discounted_cash":948.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1390.0,"discounted_cash":973.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00040210033","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1556.0,"discounted_cash":1089.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ECHO EXAM UTERUS","code_information":[{"code":"Px00040210034","type":"CDM"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1887.0,"discounted_cash":1320.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US EXAM PELVIC FOLLICLE LIMITED","code_information":[{"code":"Px00040210035","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":910.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US EXAM SCROTUM & CONTENTS","code_information":[{"code":"Px00040210036","type":"CDM"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1647.0,"discounted_cash":1152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US TRANSRECTAL","code_information":[{"code":"Px00040210037","type":"CDM"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":1234.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US TRANSRECTAL PROSTATE VOLUME","code_information":[{"code":"Px00040210038","type":"CDM"},{"code":"76873","type":"HCPCS"}],"standard_charges":[{"gross_charge":2330.0,"discounted_cash":1631.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US JOINT COMPLETE","code_information":[{"code":"Px00040210041","type":"CDM"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":509.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US INFANT HIPS DYNAMIC","code_information":[{"code":"Px00040210045","type":"CDM"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.0,"discounted_cash":2537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US INFANT HIPS STATIC","code_information":[{"code":"Px00040210046","type":"CDM"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":1200.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US GUIDE COMPRESSION REPAIR","code_information":[{"code":"Px00040210048","type":"CDM"},{"code":"76936","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":384.0,"discounted_cash":268.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00040210049","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.0,"discounted_cash":670.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US GUIDE TISSUE ABLATION","code_information":[{"code":"Px00040210050","type":"CDM"},{"code":"76940","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":908.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO GUIDE FOR TRANSFUSION","code_information":[{"code":"Px00040210051","type":"CDM"},{"code":"76941","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210052","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.0,"discounted_cash":1162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO GUIDE FOR AMNIOCENTESIS CDM","code_information":[{"code":"Px00040210053","type":"CDM"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":774.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GI ENDOSCOPIC US S&I","code_information":[{"code":"Px00040210058","type":"CDM"},{"code":"76975","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US GUIDE INTRAOPERATIVE","code_information":[{"code":"Px00040210059","type":"CDM"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":987.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO EXAMINATION PROCEDURE UNLISTED","code_information":[{"code":"Px00040210061","type":"CDM"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":910.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US UMBILICAL ARTERY ECHO CDM","code_information":[{"code":"Px00040210076","type":"CDM"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":264.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US PELVIC NON-OB COMPLETE","code_information":[{"code":"Px00040210093","type":"CDM"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":2194.0,"discounted_cash":1535.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US ABDOMEN LIMITED","code_information":[{"code":"Px00040210104","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1464.0,"discounted_cash":1024.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210113","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.0,"discounted_cash":1162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US GUIDE ENDOMYOCARD BX-RAD","code_information":[{"code":"Px00040210131","type":"CDM"},{"code":"76932","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":726.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US BREAST UNI COMPLETE","code_information":[{"code":"Px00040210136","type":"CDM"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US BREAST UNI LIMITED","code_information":[{"code":"Px00040210137","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US ABD AORTA SCRN AAA","code_information":[{"code":"Px00040210142","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MAMMO SCREEN BIL W CAD","code_information":[{"code":"Px00040310004","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":465.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEART MUSCLE IMAGING (PET)","code_information":[{"code":"Px00040410001","type":"CDM"},{"code":"78459","type":"HCPCS"}],"standard_charges":[{"gross_charge":9278.0,"discounted_cash":6494.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9278.0,"discounted_cash":6494.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET HEART IMAGE SINGLE","code_information":[{"code":"Px00040410002","type":"CDM"},{"code":"78491","type":"HCPCS"}],"standard_charges":[{"gross_charge":22133.0,"discounted_cash":15493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2476.0,"discounted_cash":1733.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET HEART IMAGE MULTIPLE","code_information":[{"code":"Px00040410003","type":"CDM"},{"code":"78492","type":"HCPCS"}],"standard_charges":[{"gross_charge":22133.0,"discounted_cash":15493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2476.0,"discounted_cash":1733.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET BRAIN METABOLIC EVAL","code_information":[{"code":"Px00040410004","type":"CDM"},{"code":"78608","type":"HCPCS"}],"standard_charges":[{"gross_charge":22133.0,"discounted_cash":15493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2476.0,"discounted_cash":1733.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET IMAGE LIMITED AREA","code_information":[{"code":"Px00040410006","type":"CDM"},{"code":"78811","type":"HCPCS"}],"standard_charges":[{"gross_charge":9278.0,"discounted_cash":6494.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":9278.0,"discounted_cash":6494.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET IMAGE SKULL MID THIGH","code_information":[{"code":"Px00040410007","type":"CDM"},{"code":"78812","type":"HCPCS"}],"standard_charges":[{"gross_charge":11593.0,"discounted_cash":8115.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11593.0,"discounted_cash":8115.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET IMAGE FULL BODY","code_information":[{"code":"Px00040410008","type":"CDM"},{"code":"78813","type":"HCPCS"}],"standard_charges":[{"gross_charge":13905.0,"discounted_cash":9733.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":13905.0,"discounted_cash":9733.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET IMAGE W CT LIMITED","code_information":[{"code":"Px00040410009","type":"CDM"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":18729.0,"discounted_cash":13110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16490.0,"discounted_cash":11543.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET IMAGE W CT SKULL MID THIGH","code_information":[{"code":"Px00040410010","type":"CDM"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":18729.0,"discounted_cash":13110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16490.0,"discounted_cash":11543.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET IMAGE W CT WHOLE BODY","code_information":[{"code":"Px00040410011","type":"CDM"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":18729.0,"discounted_cash":13110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16490.0,"discounted_cash":11543.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET CT LIMITED BONE SCAN","code_information":[{"code":"Px00040410016","type":"CDM"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":18729.0,"discounted_cash":13110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16490.0,"discounted_cash":11543.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET CT BONE SCAN","code_information":[{"code":"Px00040410017","type":"CDM"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":18729.0,"discounted_cash":13110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16490.0,"discounted_cash":11543.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PET MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT CDM","code_information":[{"code":"Px00040410020","type":"CDM"},{"code":"78429","type":"HCPCS"}],"standard_charges":[{"gross_charge":10528.0,"discounted_cash":7369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PET MYOCRD IMG PET PRFUJ 1STD REST OR STRESS CNCRNT CT CDM","code_information":[{"code":"Px00040410021","type":"CDM"},{"code":"78430","type":"HCPCS"}],"standard_charges":[{"gross_charge":22133.0,"discounted_cash":15493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PET MYOCRD IMG PET PRFUJ MLT STD RST AND STRS CNCRNT CT CDM","code_information":[{"code":"Px00040410022","type":"CDM"},{"code":"78431","type":"HCPCS"}],"standard_charges":[{"gross_charge":24446.0,"discounted_cash":17112.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PET MYOCRD IMG PET PRFUJ W METAB DUAL RADIOTRACER CDM","code_information":[{"code":"Px00040410023","type":"CDM"},{"code":"78432","type":"HCPCS"}],"standard_charges":[{"gross_charge":20073.0,"discounted_cash":14051.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PET MYOCRD IMG PET PRFUJ W METAB 2RTRACER CNCRNT CT CDM","code_information":[{"code":"Px00040410024","type":"CDM"},{"code":"78433","type":"HCPCS"}],"standard_charges":[{"gross_charge":20073.0,"discounted_cash":14051.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PET AQMBF PET REST AND PHARMACOLOGIC STRESS CDM","code_information":[{"code":"Px00040410025","type":"CDM"},{"code":"78434","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RECON CTA FOR SURG PLAN","code_information":[{"code":"Px00040910001","type":"CDM"},{"code":"G0288","type":"HCPCS"}],"standard_charges":[{"gross_charge":2208.0,"discounted_cash":1545.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTUBATION CDM","code_information":[{"code":"Px00041010003","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":530.0,"discounted_cash":371.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BLOOD DRAW ARTERIAL PUNCTURE CDM","code_information":[{"code":"Px00041010006","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":411.0,"discounted_cash":287.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00041010007","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":4848.0,"discounted_cash":3393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":612.0,"discounted_cash":428.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PULMONARY MECHANICS (VITAL CAPACITY TOTAL -  SEPARATE PROCEDURE)","code_information":[{"code":"Px00041010008","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":301.0,"discounted_cash":210.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ","code_information":[{"code":"Px00041010010","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00041010012","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PULSE OXIMETRY OVERNIGHT STUDY CDM","code_information":[{"code":"Px00041010013","type":"CDM"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":1206.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":735.0,"discounted_cash":514.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3828.0,"discounted_cash":2679.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1274.0,"discounted_cash":891.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MECHANICAL CHEST WALL OSCILL CDM","code_information":[{"code":"Px00041010023","type":"CDM"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":641.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":327.0,"discounted_cash":228.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ CDM","code_information":[{"code":"Px00041010263","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MECHANICAL VENTILATION FIRST DAY CDM","code_information":[{"code":"Px00041010290","type":"CDM"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":2877.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1816.0,"discounted_cash":1271.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010296","type":"CDM"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":3828.0,"discounted_cash":2679.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1816.0,"discounted_cash":1271.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP DAILY CDM","code_information":[{"code":"Px00041010325","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1632.0,"discounted_cash":1142.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":409.0,"discounted_cash":286.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010328","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":409.0,"discounted_cash":286.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERCUSSION VIBRATION POSTURAL DRAINAGE 3 POSITIONS OR LESS","code_information":[{"code":"Px00041010338","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERCUSSION VIBRATPOSTURAL DRAINAGE GT/4 POSITIONS CDM","code_information":[{"code":"Px00041010341","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":166.0,"discounted_cash":116.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CONGENITAL HEART DISEASE SCREEN PULSE OX MULT DET","code_information":[{"code":"Px00041010384","type":"CDM"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","code_information":[{"code":"Px00041010406","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":741.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":566.0,"discounted_cash":396.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SURFACTANT ADMINISTRATION W/O INTUBATION (LMA/LISA) CDM","code_information":[{"code":"Px00041044444","type":"CDM"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":275.0,"discounted_cash":192.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRAPULMONARY SURFACTANT ADMINISTJ THROUGH TUBE PHYS/QHP CDM","code_information":[{"code":"Px00041210001","type":"CDM"},{"code":"94610","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":316.0,"discounted_cash":221.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INHALATION TREATMENT DAILY","code_information":[{"code":"Px00041210006","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":697.0,"discounted_cash":487.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH","code_information":[{"code":"Px00041210007","type":"CDM"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":653.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":566.0,"discounted_cash":396.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CAREGIVER TRAINING DIRECT CARE STRATEGIES AND TECHNIQUES INITIAL 30MINS","code_information":[{"code":"Px00042000014","type":"CDM"},{"code":"G0541","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CAREGIVER TRAINING DIRECT CARE STRATEGIES AND TECHNIQUES ADDL 15MINS","code_information":[{"code":"Px00042000015","type":"CDM"},{"code":"G0542","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":419.0,"discounted_cash":293.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE - PER DAY","code_information":[{"code":"Px00042010108","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":148.0,"discounted_cash":103.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":37.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC APPLICATION MODALITY 1 OR MORE AREAS WHIRLPOOL","code_information":[{"code":"Px00042010117","type":"CDM"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":52.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":42.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":71.0,"discounted_cash":49.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":40.0,"discounted_cash":28.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":70.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":73.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC AQUATIC THERAPY/EXERCISES - 15 MIN","code_information":[{"code":"Px00042010141","type":"CDM"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":61.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":58.0,"discounted_cash":40.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHYSICAL MEDICINE PROCEDURE","code_information":[{"code":"Px00042010146","type":"CDM"},{"code":"97139","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":65.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THERAPEUTIC PROCEDURES GROUP 2 OR MORE INDIVIDUALS","code_information":[{"code":"Px00042010153","type":"CDM"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":39.0,"discounted_cash":27.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"Px00042010160","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC WHEELCHAIR MGMT EA 15 MIN","code_information":[{"code":"Px00042010165","type":"CDM"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":98.0,"discounted_cash":68.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS","code_information":[{"code":"Px00042010166","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":615.0,"discounted_cash":430.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","code_information":[{"code":"Px00042010173","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":350.0,"discounted_cash":245.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":634.0,"discounted_cash":443.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":72.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010264","type":"CDM"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010265","type":"CDM"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ACCIDENT REPORT OR PROVIDERS INITIAL REPORT 1040M (L AND I)","code_information":[{"code":"Px00042410056","type":"CDM"},{"code":"1040M","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410066","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410067","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":471.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00042410068","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":494.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CAREGIVER IND FUNCTIONAL TRAINING W/O PATIENT PRESENT 1ST 30 MIN CDM","code_information":[{"code":"Px00043000007","type":"CDM"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CAREGIVER IND FUNCTIONAL TRAINING W/O PATIENT PRESENT EA ADD 15 MIN CDM","code_information":[{"code":"Px00043000008","type":"CDM"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":25.0,"discounted_cash":17.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"Px00043010007","type":"CDM"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":64.0,"discounted_cash":44.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"Px00043010008","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":77.0,"discounted_cash":53.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SELF CARE MNGMENT TRAINING - ADL","code_information":[{"code":"Px00043010013","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":66.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OT EVALUATION LOW COMPLEX","code_information":[{"code":"Px00043410045","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OT EVALUATION MOD COMPLEXITY","code_information":[{"code":"Px00043410046","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":364.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00043410047","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL","code_information":[{"code":"Px00044010016","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":286.0,"discounted_cash":200.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":88.0,"discounted_cash":61.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"Px00044010042","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":314.0,"discounted_cash":219.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ORAL SPEECH DEVICE EVAL","code_information":[{"code":"Px00044010050","type":"CDM"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":263.0,"discounted_cash":184.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EVAL FOR NONSPEECH DEVICE RX","code_information":[{"code":"Px00044010051","type":"CDM"},{"code":"92605","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NON-SPEECH DEVICE SERVICE","code_information":[{"code":"Px00044010055","type":"CDM"},{"code":"92606","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC USE OF SPEECH DEVICE SERVICE","code_information":[{"code":"Px00044010062","type":"CDM"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.0,"discounted_cash":441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":631.0,"discounted_cash":441.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC USE OF SPEECH DEVICE SERVICE CDM","code_information":[{"code":"Px00044010068","type":"CDM"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.0,"discounted_cash":441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":631.0,"discounted_cash":441.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OTORHINOLARYNGOLOGICAL SERVICE/PX","code_information":[{"code":"Px00044010069","type":"CDM"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":127.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM","code_information":[{"code":"Px00044010076","type":"CDM"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":403.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":500.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":409.0,"discounted_cash":286.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM","code_information":[{"code":"Px00044010126","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":565.0,"discounted_cash":395.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":463.0,"discounted_cash":324.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":195.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION","code_information":[{"code":"Px00044410026","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":683.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":265.0,"discounted_cash":185.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MOTION FLUOROSCOPY/SWALLOW","code_information":[{"code":"Px00044410043","type":"CDM"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":329.0,"discounted_cash":230.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENDOSCOPY SWALLOW TST (FEES)","code_information":[{"code":"Px00044410054","type":"CDM"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":911.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"Px00044410063","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8871.0,"discounted_cash":6209.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2216.0,"discounted_cash":1551.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2882.0,"discounted_cash":2017.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2195.0,"discounted_cash":1536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8042.0,"discounted_cash":5629.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TONSIL ASPIRATION CDM","code_information":[{"code":"Px00045000017","type":"CDM"},{"code":"45000017","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":627.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2587.0,"discounted_cash":1810.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1000.0,"discounted_cash":700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED J TUBE REPLACEMENT CDM","code_information":[{"code":"Px00045000024","type":"CDM"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2570.0,"discounted_cash":1799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2587.0,"discounted_cash":1810.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TOCILIZUMAUB INFUSION ADMIN 1ST DOSE M0249","code_information":[{"code":"Px00045000033","type":"CDM"},{"code":"M0249","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":349.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1965.0,"discounted_cash":1375.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5974.0,"discounted_cash":4181.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5837.0,"discounted_cash":4085.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2867.0,"discounted_cash":2006.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1965.0,"discounted_cash":1375.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4122.0,"discounted_cash":2885.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1965.0,"discounted_cash":1375.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3144.0,"discounted_cash":2200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2882.0,"discounted_cash":2017.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2950.0,"discounted_cash":2065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2882.0,"discounted_cash":2017.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5156.0,"discounted_cash":3609.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2077.0,"discounted_cash":1453.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6273.0,"discounted_cash":4391.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11027.0,"discounted_cash":7718.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4600.0,"discounted_cash":3220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4600.0,"discounted_cash":3220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1809.0,"discounted_cash":1266.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1809.0,"discounted_cash":1266.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2518.0,"discounted_cash":1762.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2891.0,"discounted_cash":2023.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":702.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20130.0,"discounted_cash":14091.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7596.0,"discounted_cash":5317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED VBAC DELIVERY ONLY CDM","code_information":[{"code":"Px00045000082","type":"CDM"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED URETHRAL FB REMOVAL CDM","code_information":[{"code":"Px00045000084","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2807.0,"discounted_cash":1964.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":647.0,"discounted_cash":452.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3663.0,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12338.0,"discounted_cash":8636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED THROMBOLYTIC VENOUS THERAPY CDM","code_information":[{"code":"Px00045000090","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":9666.0,"discounted_cash":6766.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7689.0,"discounted_cash":5382.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3735.0,"discounted_cash":2614.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3735.0,"discounted_cash":2614.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":521.0,"discounted_cash":364.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED SUBCONJUNCTIVAL INJECTION CDM","code_information":[{"code":"Px00045000098","type":"CDM"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1344.0,"discounted_cash":940.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED OB FAC E&M VISIT LEVEL 1 CDM","code_information":[{"code":"Px00045000101","type":"CDM"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED OB FAC E&M VISIT LEVEL 2 CDM","code_information":[{"code":"Px00045000102","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":429.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED OB FAC E&M VISIT LEVEL 3 CDM","code_information":[{"code":"Px00045000103","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":569.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED OB FAC E&M VISIT LEVEL 4 CDM","code_information":[{"code":"Px00045000104","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1464.0,"discounted_cash":1024.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED OB FAC E&M VISIT LEVEL 5 CDM","code_information":[{"code":"Px00045000105","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":3175.0,"discounted_cash":2222.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED OB FAC CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00045000106","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":7563.0,"discounted_cash":5294.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED INCISION DRAINAGE LACRIMAL SAC CDM","code_information":[{"code":"Px00045000117","type":"CDM"},{"code":"68420","type":"HCPCS"}],"standard_charges":[{"gross_charge":8222.0,"discounted_cash":5755.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2460.0,"discounted_cash":1722.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3098.0,"discounted_cash":2168.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3098.0,"discounted_cash":2168.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2789.0,"discounted_cash":1952.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1283.0,"discounted_cash":898.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1283.0,"discounted_cash":898.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10211.0,"discounted_cash":7147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US ED EXAM CHEST CDM","code_information":[{"code":"Px00045000136","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.0,"discounted_cash":982.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US ED GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00045000138","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.0,"discounted_cash":1162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US ED ABDOMEN LIMITED CDM","code_information":[{"code":"Px00045000139","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1464.0,"discounted_cash":1024.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":981.0,"discounted_cash":686.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1819.0,"discounted_cash":1273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1301.0,"discounted_cash":910.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC US ED RETROPERITONEAL LIMITED CDM","code_information":[{"code":"Px00045000144","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":623.0,"discounted_cash":436.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED ACNE SURGERY CDM","code_information":[{"code":"Px00045001301","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CURETTAGE POSTPARTUM CDM","code_information":[{"code":"Px00045001309","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1450.0,"discounted_cash":1015.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1697.0,"discounted_cash":1187.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8801.0,"discounted_cash":6160.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED INHALATION TREATMENT CDM","code_information":[{"code":"Px00045010003","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11979.0,"discounted_cash":8385.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7231.0,"discounted_cash":5061.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1223.0,"discounted_cash":856.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2635.0,"discounted_cash":1844.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2559.0,"discounted_cash":1791.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2251.0,"discounted_cash":1575.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10128.0,"discounted_cash":7089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10128.0,"discounted_cash":7089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6586.0,"discounted_cash":4610.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2179.0,"discounted_cash":1525.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00045010019","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":702.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":475.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":468.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3740.0,"discounted_cash":2618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2195.0,"discounted_cash":1536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2195.0,"discounted_cash":1536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2214.0,"discounted_cash":1549.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5373.0,"discounted_cash":3761.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5236.0,"discounted_cash":3665.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1809.0,"discounted_cash":1266.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4138.0,"discounted_cash":2896.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1021.0,"discounted_cash":714.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1032.0,"discounted_cash":722.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18059.0,"discounted_cash":12641.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4975.0,"discounted_cash":3482.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED STRAPPING HIP CDM","code_information":[{"code":"Px00045010065","type":"CDM"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1170.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1538.0,"discounted_cash":1076.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2444.0,"discounted_cash":1710.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2140.0,"discounted_cash":1498.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4095.0,"discounted_cash":2866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8231.0,"discounted_cash":5761.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3715.0,"discounted_cash":2600.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3785.0,"discounted_cash":2649.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":939.0,"discounted_cash":657.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":692.0,"discounted_cash":484.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2939.0,"discounted_cash":2057.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":692.0,"discounted_cash":484.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2939.0,"discounted_cash":2057.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1429.0,"discounted_cash":1000.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3367.0,"discounted_cash":2356.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7962.0,"discounted_cash":5573.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3026.0,"discounted_cash":2118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3663.0,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00045010098","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00045010099","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":7179.0,"discounted_cash":5025.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2811.0,"discounted_cash":1967.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2322.0,"discounted_cash":1625.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3026.0,"discounted_cash":2118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5183.0,"discounted_cash":3628.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9978.0,"discounted_cash":6984.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1482.0,"discounted_cash":1037.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1840.0,"discounted_cash":1288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1434.0,"discounted_cash":1003.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED NASOPHARYNGOSCOPY CDM","code_information":[{"code":"Px00045010113","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE CDM","code_information":[{"code":"Px00045010115","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":4831.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9442.0,"discounted_cash":6609.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED VAGINAL DELIVERY ONLY CDM","code_information":[{"code":"Px00045010118","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":5876.0,"discounted_cash":4113.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DELIVER PLACENTA CDM","code_information":[{"code":"Px00045010119","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":9429.0,"discounted_cash":6600.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED SPONTANEOUS ABORTION FAC CDM","code_information":[{"code":"Px00045010121","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":4831.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":805.0,"discounted_cash":563.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED SEXUAL ASSAULT EXAM CDM","code_information":[{"code":"Px00045010130","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.0,"discounted_cash":1078.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2811.0,"discounted_cash":1967.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DISTAL RADIAL FRACTURE CDM","code_information":[{"code":"Px00045010138","type":"CDM"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":906.0,"discounted_cash":634.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":906.0,"discounted_cash":634.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1078.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11035.0,"discounted_cash":7724.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1026.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":894.0,"discounted_cash":625.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00045010159","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4271.0,"discounted_cash":2989.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1687.0,"discounted_cash":1180.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7849.0,"discounted_cash":5494.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9246.0,"discounted_cash":6472.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REPAIR ACHILLES TENDON CDM","code_information":[{"code":"Px00045010173","type":"CDM"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":737.0,"discounted_cash":515.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4884.0,"discounted_cash":3418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4884.0,"discounted_cash":3418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5775.0,"discounted_cash":4042.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5514.0,"discounted_cash":3859.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5514.0,"discounted_cash":3859.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5775.0,"discounted_cash":4042.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5596.0,"discounted_cash":3917.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":646.0,"discounted_cash":452.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":856.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1541.0,"discounted_cash":1078.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3342.0,"discounted_cash":2339.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4448.0,"discounted_cash":3113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":431.0,"discounted_cash":301.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1185.0,"discounted_cash":829.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5548.0,"discounted_cash":3883.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CYSTOURETHROSCOPY CDM","code_information":[{"code":"Px00045010230","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":1222.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5223.0,"discounted_cash":3656.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":920.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10500.0,"discounted_cash":7350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6320.0,"discounted_cash":4424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":963.0,"discounted_cash":674.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5373.0,"discounted_cash":3761.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1108.0,"discounted_cash":775.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1046.0,"discounted_cash":732.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":635.0,"discounted_cash":444.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6320.0,"discounted_cash":4424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8200.0,"discounted_cash":5740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8949.0,"discounted_cash":6264.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":652.0,"discounted_cash":456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":645.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":912.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":874.0,"discounted_cash":611.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1125.0,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4047.0,"discounted_cash":2832.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":703.0,"discounted_cash":492.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4669.0,"discounted_cash":3268.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2814.0,"discounted_cash":1969.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1834.0,"discounted_cash":1283.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1094.0,"discounted_cash":765.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9433.0,"discounted_cash":6603.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7849.0,"discounted_cash":5494.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8679.0,"discounted_cash":6075.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1419.0,"discounted_cash":993.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1361.0,"discounted_cash":952.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5602.0,"discounted_cash":3921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4466.0,"discounted_cash":3126.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1182.0,"discounted_cash":827.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6067.0,"discounted_cash":4246.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6079.0,"discounted_cash":4255.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PLACEMENT SETON CDM","code_information":[{"code":"Px00045010301","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5837.0,"discounted_cash":4085.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5373.0,"discounted_cash":3761.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1465.0,"discounted_cash":1025.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5373.0,"discounted_cash":3761.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3290.0,"discounted_cash":2303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":489.0,"discounted_cash":342.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":991.0,"discounted_cash":693.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1215.0,"discounted_cash":850.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":802.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5237.0,"discounted_cash":3665.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5720.0,"discounted_cash":4004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10128.0,"discounted_cash":7089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6031.0,"discounted_cash":4221.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7849.0,"discounted_cash":5494.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00045010318","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3548.0,"discounted_cash":2483.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11017.0,"discounted_cash":7711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2403.0,"discounted_cash":1682.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":434.0,"discounted_cash":303.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1607.0,"discounted_cash":1124.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1607.0,"discounted_cash":1124.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":638.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":637.0,"discounted_cash":445.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":655.0,"discounted_cash":458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":677.0,"discounted_cash":473.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":714.0,"discounted_cash":499.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":854.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":869.0,"discounted_cash":608.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":885.0,"discounted_cash":619.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":900.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8042.0,"discounted_cash":5629.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1420.0,"discounted_cash":994.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1484.0,"discounted_cash":1038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":737.0,"discounted_cash":515.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1277.0,"discounted_cash":893.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":767.0,"discounted_cash":536.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1041.0,"discounted_cash":728.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":580.0,"discounted_cash":406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1162.0,"discounted_cash":813.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3842.0,"discounted_cash":2689.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7132.0,"discounted_cash":4992.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7438.0,"discounted_cash":5206.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2374.0,"discounted_cash":1661.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00045010410","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7132.0,"discounted_cash":4992.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045010414","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2036.0,"discounted_cash":1425.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010416","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":2036.0,"discounted_cash":1425.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9569.0,"discounted_cash":6698.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7630.0,"discounted_cash":5341.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3160.0,"discounted_cash":2212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REV EYELID LAT CDM","code_information":[{"code":"Px00045010422","type":"CDM"},{"code":"21282","type":"HCPCS"}],"standard_charges":[{"gross_charge":8858.0,"discounted_cash":6200.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00045010423","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5223.0,"discounted_cash":3656.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED INCISION OF URETHRA CDM","code_information":[{"code":"Px00045010427","type":"CDM"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6273.0,"discounted_cash":4391.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6273.0,"discounted_cash":4391.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8858.0,"discounted_cash":6200.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7122.0,"discounted_cash":4985.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6273.0,"discounted_cash":4391.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00045010434","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":786.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REDUCE TESTIS TORSION CDM","code_information":[{"code":"Px00045010435","type":"CDM"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":9978.0,"discounted_cash":6984.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00045010436","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7311.0,"discounted_cash":5117.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6273.0,"discounted_cash":4391.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1432.0,"discounted_cash":1002.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":640.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6902.0,"discounted_cash":4831.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11924.0,"discounted_cash":8346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00045010444","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9450.0,"discounted_cash":6615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REPAIR VAGINA/PERINEUM CDM","code_information":[{"code":"Px00045010446","type":"CDM"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PELVIC EXAMINATION CDM","code_information":[{"code":"Px00045010447","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10163.0,"discounted_cash":7114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED BIOPSY OF CERVIX CDM","code_information":[{"code":"Px00045010451","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.0,"discounted_cash":1665.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00045010452","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":4831.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DILATION AND CURETTAGE CDM","code_information":[{"code":"Px00045010454","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":4831.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00045010455","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1341.0,"discounted_cash":938.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4203.0,"discounted_cash":2942.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PIERCE SKULL IMPLANT DEVICE CDM","code_information":[{"code":"Px00045010458","type":"CDM"},{"code":"61210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":977.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2311.0,"discounted_cash":1617.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":920.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12781.0,"discounted_cash":8946.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":437.0,"discounted_cash":305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1267.0,"discounted_cash":886.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":437.0,"discounted_cash":305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7528.0,"discounted_cash":5269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00045010475","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2444.0,"discounted_cash":1710.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7528.0,"discounted_cash":5269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REVISION OF CORNEA CDM","code_information":[{"code":"Px00045010479","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":5505.0,"discounted_cash":3853.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12446.0,"discounted_cash":8712.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1287.0,"discounted_cash":900.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6262.0,"discounted_cash":4383.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":802.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7311.0,"discounted_cash":5117.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":802.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION FEMORAL CDM","code_information":[{"code":"Px00045010493","type":"CDM"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":12358.0,"discounted_cash":8650.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":692.0,"discounted_cash":484.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9904.0,"discounted_cash":6932.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":767.0,"discounted_cash":536.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2128.0,"discounted_cash":1489.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":580.0,"discounted_cash":406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5837.0,"discounted_cash":4085.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1190.0,"discounted_cash":833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5373.0,"discounted_cash":3761.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5373.0,"discounted_cash":3761.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5837.0,"discounted_cash":4085.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2060.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10128.0,"discounted_cash":7089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5459.0,"discounted_cash":3821.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5459.0,"discounted_cash":3821.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10128.0,"discounted_cash":7089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1019.0,"discounted_cash":713.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1965.0,"discounted_cash":1375.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1262.0,"discounted_cash":883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CHEMICAL CAUTERY TISSUE CDM","code_information":[{"code":"Px00045010525","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7849.0,"discounted_cash":5494.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00045010530","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.0,"discounted_cash":1910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00045010531","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":6891.0,"discounted_cash":4823.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00045010532","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":6891.0,"discounted_cash":4823.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00045010533","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8679.0,"discounted_cash":6075.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":920.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1020.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1583.0,"discounted_cash":1108.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5752.0,"discounted_cash":4026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00045010544","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6040.0,"discounted_cash":4228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2313.0,"discounted_cash":1619.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9675.0,"discounted_cash":6772.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20420.0,"discounted_cash":14294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7849.0,"discounted_cash":5494.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00045010560","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00045010562","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00045010563","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3379.0,"discounted_cash":2365.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1078.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1038.0,"discounted_cash":726.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6024.0,"discounted_cash":4216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":844.0,"discounted_cash":590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5881.0,"discounted_cash":4116.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1583.0,"discounted_cash":1108.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1583.0,"discounted_cash":1108.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":870.0,"discounted_cash":609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6067.0,"discounted_cash":4246.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6067.0,"discounted_cash":4246.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5799.0,"discounted_cash":4059.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED SHOULDER SURGERY PROCEDURE CDM","code_information":[{"code":"Px00045010601","type":"CDM"},{"code":"23929","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7849.0,"discounted_cash":5494.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5276.0,"discounted_cash":3693.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10703.0,"discounted_cash":7492.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5669.0,"discounted_cash":3968.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2179.0,"discounted_cash":1525.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3156.0,"discounted_cash":2209.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8339.0,"discounted_cash":5837.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION CDM","code_information":[{"code":"Px00045010621","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20130.0,"discounted_cash":14091.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND CDM","code_information":[{"code":"Px00045010627","type":"CDM"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":7528.0,"discounted_cash":5269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010632","type":"CDM"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40622.0,"discounted_cash":28435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT ELBOW FRACTURE CDM","code_information":[{"code":"Px00045010633","type":"CDM"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED HAND TENDON RECONSTRUCTION CDM","code_information":[{"code":"Px00045010637","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CORRECTION OF BUNION CDM","code_information":[{"code":"Px00045010641","type":"CDM"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING CDM","code_information":[{"code":"Px00045010642","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":8858.0,"discounted_cash":6200.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED HEMORRHOIDOPEXY BY STAPLING CDM","code_information":[{"code":"Px00045010645","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM","code_information":[{"code":"Px00045010647","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":16226.0,"discounted_cash":11358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8956.0,"discounted_cash":6269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT CDM","code_information":[{"code":"Px00045010649","type":"CDM"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":8956.0,"discounted_cash":6269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5837.0,"discounted_cash":4085.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19236.0,"discounted_cash":13465.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7689.0,"discounted_cash":5382.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYE CDM","code_information":[{"code":"Px00045010663","type":"CDM"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":6642.0,"discounted_cash":4649.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":430.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED HYMENOTOMY SIMPLE INCISION CDM","code_information":[{"code":"Px00045010665","type":"CDM"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5837.0,"discounted_cash":4085.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4322.0,"discounted_cash":3025.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REPLANTATION DIGIT COMPLETE CDM","code_information":[{"code":"Px00045010675","type":"CDM"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":8233.0,"discounted_cash":5763.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED HYPOTHERMIA ILL NEONATE CDM","code_information":[{"code":"Px00045010676","type":"CDM"},{"code":"99184","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":490.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5331.0,"discounted_cash":3731.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1379.0,"discounted_cash":965.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED ESCHAROTOMY ADDL INCISION CDM","code_information":[{"code":"Px00045010684","type":"CDM"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":420.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00045010685","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":5744.0,"discounted_cash":4020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3107.0,"discounted_cash":2174.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11667.0,"discounted_cash":8166.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REPAIR PALATE CDM","code_information":[{"code":"Px00045010690","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":18059.0,"discounted_cash":12641.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REVISE FINGER JOINT CDM","code_information":[{"code":"Px00045010691","type":"CDM"},{"code":"26535","type":"HCPCS"}],"standard_charges":[{"gross_charge":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4832.0,"discounted_cash":3382.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6781.0,"discounted_cash":4746.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1965.0,"discounted_cash":1375.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1128.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2195.0,"discounted_cash":1536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2214.0,"discounted_cash":1549.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2066.0,"discounted_cash":1446.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED STRAPPING UNNA BOOT CDM","code_information":[{"code":"Px00045010706","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":31970.0,"discounted_cash":22379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010713","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"discounted_cash":744.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":667.0,"discounted_cash":466.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1642.0,"discounted_cash":1149.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CATHJ UMBILICAL VEIN DX/THER NB CDM","code_information":[{"code":"Px00045010718","type":"CDM"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10075.0,"discounted_cash":7052.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION HUMERAL CDM","code_information":[{"code":"Px00045010721","type":"CDM"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":15056.0,"discounted_cash":10539.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4459.0,"discounted_cash":3121.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4063.0,"discounted_cash":2844.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM","code_information":[{"code":"Px00045010728","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2262.0,"discounted_cash":1583.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4842.0,"discounted_cash":3389.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2294.0,"discounted_cash":1605.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":981.0,"discounted_cash":686.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":603.0,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED EXCISION CHALAZION SINGLE CDM","code_information":[{"code":"Px00045010737","type":"CDM"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":660.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":578.0,"discounted_cash":404.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4339.0,"discounted_cash":3037.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6067.0,"discounted_cash":4246.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40622.0,"discounted_cash":28435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00045010752","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40622.0,"discounted_cash":28435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40622.0,"discounted_cash":28435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1102.0,"discounted_cash":771.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00045010760","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":439.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":899.0,"discounted_cash":629.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED FETAL NONSTRESS TEST CDM","code_information":[{"code":"Px00045010765","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1475.0,"discounted_cash":1032.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11666.0,"discounted_cash":8166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4976.0,"discounted_cash":3483.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1054.0,"discounted_cash":737.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11666.0,"discounted_cash":8166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":947.0,"discounted_cash":662.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":605.0,"discounted_cash":423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1767.0,"discounted_cash":1236.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2294.0,"discounted_cash":1605.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1027.0,"discounted_cash":718.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2437.0,"discounted_cash":1705.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3173.0,"discounted_cash":2221.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2949.0,"discounted_cash":2064.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":617.0,"discounted_cash":431.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3173.0,"discounted_cash":2221.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1307.0,"discounted_cash":914.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":904.0,"discounted_cash":632.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":605.0,"discounted_cash":423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1112.0,"discounted_cash":778.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8435.0,"discounted_cash":5904.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2234.0,"discounted_cash":1563.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PERQ CERVICOTHORACIC INJECT CDM","code_information":[{"code":"Px00045010809","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":11687.0,"discounted_cash":8180.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PERQ LUMBOSACRAL INJECTION CDM","code_information":[{"code":"Px00045010811","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":11687.0,"discounted_cash":8180.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40622.0,"discounted_cash":28435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9267.0,"discounted_cash":6486.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4495.0,"discounted_cash":3146.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":392.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED STRAPPING SHOULDER CDM","code_information":[{"code":"Px00045010831","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2367.0,"discounted_cash":1656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6067.0,"discounted_cash":4246.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2765.0,"discounted_cash":1935.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5383.0,"discounted_cash":3768.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9433.0,"discounted_cash":6603.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9433.0,"discounted_cash":6603.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":691.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":758.0,"discounted_cash":530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":410.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5828.0,"discounted_cash":4079.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4212.0,"discounted_cash":2948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4242.0,"discounted_cash":2969.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6838.0,"discounted_cash":4786.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2297.0,"discounted_cash":1607.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10624.0,"discounted_cash":7436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3956.0,"discounted_cash":2769.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2865.0,"discounted_cash":2005.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1068.0,"discounted_cash":747.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6275.0,"discounted_cash":4392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6275.0,"discounted_cash":4392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":603.0,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED BX INTRANASAL MUCOSA CDM","code_information":[{"code":"Px00045010878","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10201.0,"discounted_cash":7140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20130.0,"discounted_cash":14091.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8922.0,"discounted_cash":6245.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7016.0,"discounted_cash":4911.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9584.0,"discounted_cash":6708.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2883.0,"discounted_cash":2018.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3677.0,"discounted_cash":2573.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8858.0,"discounted_cash":6200.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3785.0,"discounted_cash":2649.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5027.0,"discounted_cash":3518.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6201.0,"discounted_cash":4340.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":947.0,"discounted_cash":662.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6275.0,"discounted_cash":4392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6275.0,"discounted_cash":4392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED PRESSURE TREATMENT ESOPHAGUS CDM","code_information":[{"code":"Px00045010902","type":"CDM"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":5125.0,"discounted_cash":3587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3663.0,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2322.0,"discounted_cash":1625.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7443.0,"discounted_cash":5210.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED REP PERINEAL APRCH CDM","code_information":[{"code":"Px00045010912","type":"CDM"},{"code":"45541","type":"HCPCS"}],"standard_charges":[{"gross_charge":7999.0,"discounted_cash":5599.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8690.0,"discounted_cash":6083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2811.0,"discounted_cash":1967.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1262.0,"discounted_cash":883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11940.0,"discounted_cash":8358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5287.0,"discounted_cash":3700.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8956.0,"discounted_cash":6269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8956.0,"discounted_cash":6269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":638.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED ORCHIOPEXY INGUINAL CDM","code_information":[{"code":"Px00045010927","type":"CDM"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":11027.0,"discounted_cash":7718.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED COLPOSCOPY VULVA CDM","code_information":[{"code":"Px00045010928","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1078.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":412.0,"discounted_cash":288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED COLPOTOMY WITH EXPLORATION CDM","code_information":[{"code":"Px00045010933","type":"CDM"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8802.0,"discounted_cash":6161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CAUTERIZATION CHEMICAL CERVIX CDM","code_information":[{"code":"Px00045010936","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5468.0,"discounted_cash":3827.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1078.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1191.0,"discounted_cash":833.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9563.0,"discounted_cash":6694.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2297.0,"discounted_cash":1607.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2297.0,"discounted_cash":1607.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2365.0,"discounted_cash":1655.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2894.0,"discounted_cash":2025.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":556.0,"discounted_cash":389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1206.0,"discounted_cash":844.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":936.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3073.0,"discounted_cash":2151.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2882.0,"discounted_cash":2017.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3370.0,"discounted_cash":2359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7689.0,"discounted_cash":5382.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED RECON EYELID CDM","code_information":[{"code":"Px00045010959","type":"CDM"},{"code":"67950","type":"HCPCS"}],"standard_charges":[{"gross_charge":7528.0,"discounted_cash":5269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":943.0,"discounted_cash":660.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":958.0,"discounted_cash":670.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED VENOUS PRESSURE DETERMINATION CDM","code_information":[{"code":"Px00045010964","type":"CDM"},{"code":"93770","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":498.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TRAUMA ACT FULL WO PHOSP NOTIF CDM","code_information":[{"code":"Px00045010969","type":"CDM"},{"code":"TR450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":2590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":623.0,"discounted_cash":436.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TRAUMA ACT PART WO PHOSP NOTIF CDM","code_information":[{"code":"Px00045010989","type":"CDM"},{"code":"TR450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":2590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":523.0,"discounted_cash":366.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":427.0,"discounted_cash":298.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":799.0,"discounted_cash":559.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2195.0,"discounted_cash":1536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":620.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2228.0,"discounted_cash":1559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TELEHEALTH FACILITY FEE CDM","code_information":[{"code":"Px00045011097","type":"CDM"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3304.0,"discounted_cash":2312.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":886.0,"discounted_cash":620.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1798.0,"discounted_cash":1258.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1798.0,"discounted_cash":1258.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4884.0,"discounted_cash":3418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1583.0,"discounted_cash":1108.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5799.0,"discounted_cash":4059.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20593.0,"discounted_cash":14415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6729.0,"discounted_cash":4710.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8216.0,"discounted_cash":5751.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":664.0,"discounted_cash":464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4825.0,"discounted_cash":3377.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":737.0,"discounted_cash":515.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5449.0,"discounted_cash":3814.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10067.0,"discounted_cash":7046.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00045013082","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5881.0,"discounted_cash":4116.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":545.0,"discounted_cash":381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5461.0,"discounted_cash":3822.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":836.0,"discounted_cash":585.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1328.0,"discounted_cash":929.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED APPLY FINGER CAST CDM","code_information":[{"code":"Px00045013105","type":"CDM"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1127.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CYLINDER CAST APPLICATION CDM","code_information":[{"code":"Px00045013122","type":"CDM"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":752.0,"discounted_cash":526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":515.0,"discounted_cash":360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED STRAPPING OF KNEE CDM","code_information":[{"code":"Px00045013135","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED STRAPPING OF TOES CDM","code_information":[{"code":"Px00045013139","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED WINDOWING OF CAST CDM","code_information":[{"code":"Px00045013151","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":785.0,"discounted_cash":549.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1267.0,"discounted_cash":886.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2729.0,"discounted_cash":1910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2195.0,"discounted_cash":1536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":686.0,"discounted_cash":480.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00045013187","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":331.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17288.0,"discounted_cash":12101.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1059.0,"discounted_cash":741.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00045013192","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00045013194","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":737.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3198.0,"discounted_cash":2238.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4166.0,"discounted_cash":2916.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00045013197","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY WITH BIOPSY CDM","code_information":[{"code":"Px00045013198","type":"CDM"},{"code":"31576","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4058.0,"discounted_cash":2840.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4324.0,"discounted_cash":3026.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY CDM","code_information":[{"code":"Px00045013201","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.0,"discounted_cash":1614.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00045013202","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.0,"discounted_cash":1614.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED VISUALIZATION OF WINDPIPE CDM","code_information":[{"code":"Px00045013203","type":"CDM"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.0,"discounted_cash":1024.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8375.0,"discounted_cash":5862.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11549.0,"discounted_cash":8084.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20130.0,"discounted_cash":14091.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11667.0,"discounted_cash":8166.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11667.0,"discounted_cash":8166.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2729.0,"discounted_cash":1910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2729.0,"discounted_cash":1910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2729.0,"discounted_cash":1910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":802.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2729.0,"discounted_cash":1910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6089.0,"discounted_cash":4262.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":702.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":702.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3000.0,"discounted_cash":2100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4695.0,"discounted_cash":3286.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9623.0,"discounted_cash":6736.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1545.0,"discounted_cash":1081.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6040.0,"discounted_cash":4228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEXIBLE BRUSH CDM","code_information":[{"code":"Px00045013237","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.0,"discounted_cash":1133.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2262.0,"discounted_cash":1583.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2939.0,"discounted_cash":2057.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":947.0,"discounted_cash":662.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":802.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":509.0,"discounted_cash":356.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00045014038","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":4848.0,"discounted_cash":3393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4444.0,"discounted_cash":3110.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2005.0,"discounted_cash":1403.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3431.0,"discounted_cash":2401.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED FAC PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00045014048","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.0,"discounted_cash":1312.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045014050","type":"CDM"},{"code":"46601","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22372.0,"discounted_cash":15660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4851.0,"discounted_cash":3395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16623.0,"discounted_cash":11636.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8737.0,"discounted_cash":6115.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2549.0,"discounted_cash":1784.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2770.0,"discounted_cash":1939.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BREATHING RESPONSE TO HYPOXIA","code_information":[{"code":"Px00046010001","type":"CDM"},{"code":"94450","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":342.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1668.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1274.0,"discounted_cash":891.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1308.0,"discounted_cash":915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CO/MEMBANE DIFFUSE CAPACITY","code_information":[{"code":"Px00046010012","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":669.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":889.0,"discounted_cash":622.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","code_information":[{"code":"Px00046010026","type":"CDM"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":731.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":347.0,"discounted_cash":242.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOPULMONARY EXERCISE TESTING","code_information":[{"code":"Px00046010040","type":"CDM"},{"code":"94621","type":"HCPCS"}],"standard_charges":[{"gross_charge":1796.0,"discounted_cash":1257.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1274.0,"discounted_cash":891.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PULMONARY STRESS TESTING - SIX MINUTE WALK CDM","code_information":[{"code":"Px00046010048","type":"CDM"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.0,"discounted_cash":915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RESPIRATORY FLOW VOLUME LOOP","code_information":[{"code":"Px00046010053","type":"CDM"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":342.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":740.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SPIROMETRY PRE POST BRONCHODILATOR CDM","code_information":[{"code":"Px00046010063","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1681.0,"discounted_cash":1176.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":709.0,"discounted_cash":496.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","code_information":[{"code":"Px00046010080","type":"CDM"},{"code":"94690","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":117.0,"discounted_cash":81.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST CDM","code_information":[{"code":"Px00046010089","type":"CDM"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)","code_information":[{"code":"Px00046010090","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":301.0,"discounted_cash":210.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP","code_information":[{"code":"Px00046010091","type":"CDM"},{"code":"94680","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":342.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":465.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":740.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PURE TONE AUDIOMETRY AIR ONLY","code_information":[{"code":"Px00047010003","type":"CDM"},{"code":"92552","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC POSITIONAL NYSTAGMUS TEST","code_information":[{"code":"Px00047010025","type":"CDM"},{"code":"92532","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1294.0,"discounted_cash":905.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TYMPANOMETRY","code_information":[{"code":"Px00047110012","type":"CDM"},{"code":"92567","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":175.0,"discounted_cash":122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD CDM","code_information":[{"code":"Px00047110025","type":"CDM"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":392.0,"discounted_cash":274.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL","code_information":[{"code":"Px00047110026","type":"CDM"},{"code":"92588","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":579.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":392.0,"discounted_cash":274.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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: WSH LOCATION  (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","code_information":[{"code":"Px00048010001","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2403.0,"discounted_cash":1682.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1855.0,"discounted_cash":1298.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX","code_information":[{"code":"Px00048010002","type":"CDM"},{"code":"92961","type":"HCPCS"}],"standard_charges":[{"gross_charge":2026.0,"discounted_cash":1418.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT","code_information":[{"code":"Px00048010007","type":"CDM"},{"code":"93317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":704.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1902.0,"discounted_cash":1331.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1160.0,"discounted_cash":812.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1128.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R","code_information":[{"code":"Px00048010063","type":"CDM"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":2673.0,"discounted_cash":1871.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ","code_information":[{"code":"Px00048010064","type":"CDM"},{"code":"93318","type":"HCPCS"}],"standard_charges":[{"gross_charge":1941.0,"discounted_cash":1358.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD PW & CW","code_information":[{"code":"Px00048010066","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DOP ECHOCARD COLOR FLOW VELOCITY MAPPING CDM","code_information":[{"code":"Px00048010067","type":"CDM"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO W/WO CONT STRESS MONITOR","code_information":[{"code":"Px00048010069","type":"CDM"},{"code":"C8930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2694.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TEE CONG PROBE IMAGE & REPT","code_information":[{"code":"Px00048010072","type":"CDM"},{"code":"93315","type":"HCPCS"}],"standard_charges":[{"gross_charge":2763.0,"discounted_cash":1934.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1172.0,"discounted_cash":820.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ECHO TEE CONGENITAL PROBE ONLY","code_information":[{"code":"Px00048010073","type":"CDM"},{"code":"93316","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"discounted_cash":1850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1609.0,"discounted_cash":1126.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","code_information":[{"code":"Px00048010074","type":"CDM"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":653.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST","code_information":[{"code":"Px00048010075","type":"CDM"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1331.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","code_information":[{"code":"Px00048010076","type":"CDM"},{"code":"93662","type":"HCPCS"}],"standard_charges":[{"gross_charge":9537.0,"discounted_cash":6675.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TTE 2D W/WO CONTRAST DOP COLOR","code_information":[{"code":"Px00048010077","type":"CDM"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1905.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2908.0,"discounted_cash":2035.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PM DEVICE PROGR EVAL DUAL","code_information":[{"code":"Px00048010082","type":"CDM"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PRGRMG EVAL SINGLE IMPLANTABLE DFB","code_information":[{"code":"Px00048010084","type":"CDM"},{"code":"93282","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM","code_information":[{"code":"Px00048010088","type":"CDM"},{"code":"93286","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PRE-OP ICD DEVICE EVAL","code_information":[{"code":"Px00048010089","type":"CDM"},{"code":"93287","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON","code_information":[{"code":"Px00048010090","type":"CDM"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":191.0,"discounted_cash":133.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTERROG DEVICE EVAL HEART","code_information":[{"code":"Px00048010091","type":"CDM"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":191.0,"discounted_cash":133.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRAVENTRICULAR PACING","code_information":[{"code":"Px00048010097","type":"CDM"},{"code":"93612","type":"HCPCS"}],"standard_charges":[{"gross_charge":10602.0,"discounted_cash":7421.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING","code_information":[{"code":"Px00048010109","type":"CDM"},{"code":"93613","type":"HCPCS"}],"standard_charges":[{"gross_charge":16179.0,"discounted_cash":11325.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INDUCTION ARRHYTHMIA ELECTRICAL PACING","code_information":[{"code":"Px00048010110","type":"CDM"},{"code":"93618","type":"HCPCS"}],"standard_charges":[{"gross_charge":10602.0,"discounted_cash":7421.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION","code_information":[{"code":"Px00048010111","type":"CDM"},{"code":"93619","type":"HCPCS"}],"standard_charges":[{"gross_charge":20730.0,"discounted_cash":14511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10211.0,"discounted_cash":7147.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","code_information":[{"code":"Px00048010112","type":"CDM"},{"code":"93620","type":"HCPCS"}],"standard_charges":[{"gross_charge":21921.0,"discounted_cash":15344.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10798.0,"discounted_cash":7558.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","code_information":[{"code":"Px00048010113","type":"CDM"},{"code":"93621","type":"HCPCS"}],"standard_charges":[{"gross_charge":8801.0,"discounted_cash":6160.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC","code_information":[{"code":"Px00048010114","type":"CDM"},{"code":"93622","type":"HCPCS"}],"standard_charges":[{"gross_charge":12051.0,"discounted_cash":8435.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS","code_information":[{"code":"Px00048010115","type":"CDM"},{"code":"93623","type":"HCPCS"}],"standard_charges":[{"gross_charge":7662.0,"discounted_cash":5363.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE","code_information":[{"code":"Px00048010116","type":"CDM"},{"code":"93640","type":"HCPCS"}],"standard_charges":[{"gross_charge":7888.0,"discounted_cash":5521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN","code_information":[{"code":"Px00048010117","type":"CDM"},{"code":"93641","type":"HCPCS"}],"standard_charges":[{"gross_charge":7855.0,"discounted_cash":5498.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","code_information":[{"code":"Px00048010118","type":"CDM"},{"code":"93642","type":"HCPCS"}],"standard_charges":[{"gross_charge":6735.0,"discounted_cash":4714.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3059.0,"discounted_cash":2141.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION","code_information":[{"code":"Px00048010119","type":"CDM"},{"code":"93650","type":"HCPCS"}],"standard_charges":[{"gross_charge":19446.0,"discounted_cash":13612.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10903.0,"discounted_cash":7632.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","code_information":[{"code":"Px00048010122","type":"CDM"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.0,"discounted_cash":1569.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1308.0,"discounted_cash":915.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT","code_information":[{"code":"Px00048010134","type":"CDM"},{"code":"93624","type":"HCPCS"}],"standard_charges":[{"gross_charge":10211.0,"discounted_cash":7147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10211.0,"discounted_cash":7147.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MEDICATION ADMIN & HEMODYNAMIC MEASURMENT CDM","code_information":[{"code":"Px00048010140","type":"CDM"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1852.0,"discounted_cash":1296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1426.0,"discounted_cash":998.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","code_information":[{"code":"Px00048010160","type":"CDM"},{"code":"93644","type":"HCPCS"}],"standard_charges":[{"gross_charge":8760.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTERROGATION VAD IN PERSON","code_information":[{"code":"Px00048010162","type":"CDM"},{"code":"93750","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TIS CRTJ ST CONGENITAL CARDIAC ANOMAL 1ST SHUNT CDM","code_information":[{"code":"Px00048100004","type":"CDM"},{"code":"33745","type":"HCPCS"}],"standard_charges":[{"gross_charge":62982.0,"discounted_cash":44087.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TIS CRTJ ST CONGENITAL CARDIAC ANOMAL EA ADDL CDM","code_information":[{"code":"Px00048100005","type":"CDM"},{"code":"33746","type":"HCPCS"}],"standard_charges":[{"gross_charge":31494.0,"discounted_cash":22045.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD CDM","code_information":[{"code":"Px00048100006","type":"CDM"},{"code":"33741","type":"HCPCS"}],"standard_charges":[{"gross_charge":3111.0,"discounted_cash":2177.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ TCAT US ABLATION NERVES INNERVATING P-ART CDM","code_information":[{"code":"Px00048100010","type":"CDM"},{"code":"0632T","type":"HCPCS"}],"standard_charges":[{"gross_charge":75690.0,"discounted_cash":52983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REVASC LITHOTRIP TIBI/PERONE CDM","code_information":[{"code":"Px00048100011","type":"CDM"},{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"gross_charge":47812.0,"discounted_cash":33468.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13042.0,"discounted_cash":9129.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13042.0,"discounted_cash":9129.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13178.0,"discounted_cash":9224.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13178.0,"discounted_cash":9224.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11648.0,"discounted_cash":8153.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC ST RPR COARCJ THRC/AA ACRS MAJ SIDE BRNCH","code_information":[{"code":"Px00048100037","type":"CDM"},{"code":"33894","type":"HCPCS"}],"standard_charges":[{"gross_charge":33511.0,"discounted_cash":23457.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC ST RPR COARCJ THRC/AA XCRSG MAJ SIDE BRNCH CDM","code_information":[{"code":"Px00048100038","type":"CDM"},{"code":"33895","type":"HCPCS"}],"standard_charges":[{"gross_charge":30404.0,"discounted_cash":21282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TCAT RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ","code_information":[{"code":"Px00048100039","type":"CDM"},{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"gross_charge":23491.0,"discounted_cash":16443.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA CDM","code_information":[{"code":"Px00048100040","type":"CDM"},{"code":"33897","type":"HCPCS"}],"standard_charges":[{"gross_charge":2124.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ UNI CDM","code_information":[{"code":"Px00048100042","type":"CDM"},{"code":"33900","type":"HCPCS"}],"standard_charges":[{"gross_charge":47812.0,"discounted_cash":33468.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ BI CDM","code_information":[{"code":"Px00048100043","type":"CDM"},{"code":"33901","type":"HCPCS"}],"standard_charges":[{"gross_charge":47812.0,"discounted_cash":33468.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST ABNOR CONNJ UNILATERAL CDM","code_information":[{"code":"Px00048100044","type":"CDM"},{"code":"33902","type":"HCPCS"}],"standard_charges":[{"gross_charge":77370.0,"discounted_cash":54159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ P-ART REVSC ST 1ST ABNORMAL CONNJ BILATERAL CDM","code_information":[{"code":"Px00048100045","type":"CDM"},{"code":"33903","type":"HCPCS"}],"standard_charges":[{"gross_charge":46328.0,"discounted_cash":32429.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY UNI CDM","code_information":[{"code":"Px00048100046","type":"CDM"},{"code":"93569","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY BI CDM","code_information":[{"code":"Px00048100047","type":"CDM"},{"code":"93573","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SLCTV PULM VEN ANGIOGRAPHY CDM","code_information":[{"code":"Px00048100048","type":"CDM"},{"code":"93574","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SLCTV PULM ANGRPH MAPCA CHD EA CDM","code_information":[{"code":"Px00048100049","type":"CDM"},{"code":"93575","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ P-ART RESC EACH ADD CDM","code_information":[{"code":"Px00048100058","type":"CDM"},{"code":"33904","type":"HCPCS"}],"standard_charges":[{"gross_charge":1214.0,"discounted_cash":849.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PRQ AV FSTL CRTJ UXTR 1 ACS CDM","code_information":[{"code":"Px00048100059","type":"CDM"},{"code":"36836","type":"HCPCS"}],"standard_charges":[{"gross_charge":65189.0,"discounted_cash":45632.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HEART INSTANT FLOW RESERVE MEASURE CDM","code_information":[{"code":"Px00048100062","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":496.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC L HRT CATH CHD IMG CATH TRGT ZON NML/ABNL NT CNJ","code_information":[{"code":"Px00048100067","type":"CDM"},{"code":"93595","type":"HCPCS"}],"standard_charges":[{"gross_charge":11587.0,"discounted_cash":8110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOGRAPHY CHD VENOVENOUS COLTRL AT/ABOVE HRT","code_information":[{"code":"Px00048100078","type":"CDM"},{"code":"93587","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOGRAPHY CHD ANOMALOUS/PERSISTENT SVC NT DRG CDM","code_information":[{"code":"Px00048100092","type":"CDM"},{"code":"93584","type":"HCPCS"}],"standard_charges":[{"gross_charge":3726.0,"discounted_cash":2608.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOGRAPHY CHD AZYGOS/HEMIAZYGOS VENOUS SYSTEM CDM","code_information":[{"code":"Px00048100093","type":"CDM"},{"code":"93585","type":"HCPCS"}],"standard_charges":[{"gross_charge":2375.0,"discounted_cash":1662.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOGRAPHY CHD CORONARY SINUS CDM","code_information":[{"code":"Px00048100094","type":"CDM"},{"code":"93586","type":"HCPCS"}],"standard_charges":[{"gross_charge":3650.0,"discounted_cash":2555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOGRAPHY CHD VENOVENOUS COLTRL AT/ABOVE HRT CDM","code_information":[{"code":"Px00048100095","type":"CDM"},{"code":"93587","type":"HCPCS"}],"standard_charges":[{"gross_charge":2375.0,"discounted_cash":1662.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VENOGRAPHY CHD VENOVENOUS COLLATERAL BELOW HEART CDM","code_information":[{"code":"Px00048100096","type":"CDM"},{"code":"93588","type":"HCPCS"}],"standard_charges":[{"gross_charge":7158.0,"discounted_cash":5010.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ TCAT PLMT NTRAC ST 2+LES 2+ST 2+C SEGMENTS CDM","code_information":[{"code":"Px00048100131","type":"CDM"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":25455.0,"discounted_cash":17818.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ERGONOVINE PROVOCATION TST","code_information":[{"code":"Px00048110001","type":"CDM"},{"code":"93024","type":"HCPCS"}],"standard_charges":[{"gross_charge":4313.0,"discounted_cash":3019.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1151.0,"discounted_cash":805.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TMVI PERCUTANEOUS APPROACH","code_information":[{"code":"Px00048110002","type":"CDM"},{"code":"0483T","type":"HCPCS"}],"standard_charges":[{"gross_charge":14015.0,"discounted_cash":9810.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TMVI TRANSTHORACIC EXPOSURE","code_information":[{"code":"Px00048110003","type":"CDM"},{"code":"0484T","type":"HCPCS"}],"standard_charges":[{"gross_charge":14015.0,"discounted_cash":9810.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC RPR A-AO NDGFT","code_information":[{"code":"Px00048110004","type":"CDM"},{"code":"34701","type":"HCPCS"}],"standard_charges":[{"gross_charge":17100.0,"discounted_cash":11970.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17100.0,"discounted_cash":11970.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC RPR A-UNILAC NDGFT","code_information":[{"code":"Px00048110006","type":"CDM"},{"code":"34703","type":"HCPCS"}],"standard_charges":[{"gross_charge":17100.0,"discounted_cash":11970.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17100.0,"discounted_cash":11970.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVAC RPR A-BIILIAC NDGFT","code_information":[{"code":"Px00048110008","type":"CDM"},{"code":"34705","type":"HCPCS"}],"standard_charges":[{"gross_charge":25651.0,"discounted_cash":17955.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC RPR A-BIILIAC RPT","code_information":[{"code":"Px00048110010","type":"CDM"},{"code":"34706","type":"HCPCS"}],"standard_charges":[{"gross_charge":25946.0,"discounted_cash":18162.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":32674.0,"discounted_cash":22871.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":32338.0,"discounted_cash":22636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":32338.0,"discounted_cash":22636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":26948.0,"discounted_cash":18863.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":32338.0,"discounted_cash":22636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CABG ADDL BRANCH","code_information":[{"code":"Px00048110016","type":"CDM"},{"code":"C9605","type":"HCPCS"}],"standard_charges":[{"gross_charge":26948.0,"discounted_cash":18863.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":32674.0,"discounted_cash":22871.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CHRONIC SINGLE","code_information":[{"code":"Px00048110018","type":"CDM"},{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"gross_charge":32338.0,"discounted_cash":22636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CHRONIC ADDL BRANCH","code_information":[{"code":"Px00048110019","type":"CDM"},{"code":"C9608","type":"HCPCS"}],"standard_charges":[{"gross_charge":26948.0,"discounted_cash":18863.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPRE EP EVAL ABLTJ 3D MAPG TX SVT","code_information":[{"code":"Px00048110020","type":"CDM"},{"code":"93653","type":"HCPCS"}],"standard_charges":[{"gross_charge":49094.0,"discounted_cash":34365.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPRE EP EVAL ABLTJ 3D MAPG TX VT","code_information":[{"code":"Px00048110021","type":"CDM"},{"code":"93654","type":"HCPCS"}],"standard_charges":[{"gross_charge":49094.0,"discounted_cash":34365.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON","code_information":[{"code":"Px00048110022","type":"CDM"},{"code":"93655","type":"HCPCS"}],"standard_charges":[{"gross_charge":49094.0,"discounted_cash":34365.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION","code_information":[{"code":"Px00048110023","type":"CDM"},{"code":"93656","type":"HCPCS"}],"standard_charges":[{"gross_charge":49094.0,"discounted_cash":34365.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","code_information":[{"code":"Px00048110024","type":"CDM"},{"code":"93657","type":"HCPCS"}],"standard_charges":[{"gross_charge":49094.0,"discounted_cash":34365.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":21015.0,"discounted_cash":14710.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16760.0,"discounted_cash":11732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":26629.0,"discounted_cash":18640.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":26629.0,"discounted_cash":18640.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":25454.0,"discounted_cash":17817.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":25455.0,"discounted_cash":17818.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":21213.0,"discounted_cash":14849.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML ATH/ANGIO ADDL BRANCH","code_information":[{"code":"Px00048110032","type":"CDM"},{"code":"92934","type":"HCPCS"}],"standard_charges":[{"gross_charge":21213.0,"discounted_cash":14849.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":25454.0,"discounted_cash":17817.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERT COR STENT BYPASS GRAFT TRLUML REVASC ADDL VESSEL","code_information":[{"code":"Px00048110034","type":"CDM"},{"code":"92938","type":"HCPCS"}],"standard_charges":[{"gross_charge":21213.0,"discounted_cash":14849.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":25454.0,"discounted_cash":17817.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":21213.0,"discounted_cash":14849.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":21213.0,"discounted_cash":14849.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ TRANSCATH CLOSURE PDA","code_information":[{"code":"Px00048110038","type":"CDM"},{"code":"93582","type":"HCPCS"}],"standard_charges":[{"gross_charge":45707.0,"discounted_cash":31994.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ TRANSCATH SEPTAL REDUXN","code_information":[{"code":"Px00048110039","type":"CDM"},{"code":"93583","type":"HCPCS"}],"standard_charges":[{"gross_charge":3407.0,"discounted_cash":2384.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC RPR ILIO-ILIAC NDGFT","code_information":[{"code":"Px00048110042","type":"CDM"},{"code":"34707","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":2072.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EVASC RPR ILIO-ILIAC RPT","code_information":[{"code":"Px00048110043","type":"CDM"},{"code":"34708","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":2072.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PLMT XTN PROSTH EVASC RPR","code_information":[{"code":"Px00048110044","type":"CDM"},{"code":"34709","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":2072.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DLYD PLMT XTN PROSTH 1ST VSL","code_information":[{"code":"Px00048110045","type":"CDM"},{"code":"34710","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":1037.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DLYD PLMT XTN PROSTH EA ADDL","code_information":[{"code":"Px00048110046","type":"CDM"},{"code":"34711","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":1037.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ ACCESS & CLSR FEM ART","code_information":[{"code":"Px00048110048","type":"CDM"},{"code":"34713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9488.0,"discounted_cash":6641.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NJX NONCMPND SCLRSNT 1 VEIN","code_information":[{"code":"Px00048110052","type":"CDM"},{"code":"36465","type":"HCPCS"}],"standard_charges":[{"gross_charge":7134.0,"discounted_cash":4993.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TTVR PERCUTANEOUS APPROACH INITIAL PROSTHESIS CDM","code_information":[{"code":"Px00048110060","type":"CDM"},{"code":"0569T","type":"HCPCS"}],"standard_charges":[{"gross_charge":17836.0,"discounted_cash":12485.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TTVR PERCUTANEOUS APPROACH EACH ADDL PROSTHESIS CDM","code_information":[{"code":"Px00048110061","type":"CDM"},{"code":"0570T","type":"HCPCS"}],"standard_charges":[{"gross_charge":11500.0,"discounted_cash":8050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THROMBOLYSIS CORONARY INTRAVENOUS INFUSION","code_information":[{"code":"Px00048110072","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":833.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REVASC INTRAVASC LITHOTRIPSY","code_information":[{"code":"Px00048110073","type":"CDM"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":47812.0,"discounted_cash":33468.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REVASC INTRA LITHOTRIP-STENT","code_information":[{"code":"Px00048110074","type":"CDM"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":72953.0,"discounted_cash":51067.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY","code_information":[{"code":"Px00048110101","type":"CDM"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":8823.0,"discounted_cash":6176.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH","code_information":[{"code":"Px00048110103","type":"CDM"},{"code":"92975","type":"HCPCS"}],"standard_charges":[{"gross_charge":4444.0,"discounted_cash":3110.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7688.0,"discounted_cash":5381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL","code_information":[{"code":"Px00048110107","type":"CDM"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":7844.0,"discounted_cash":5490.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REVISION OF AORTIC VALVE","code_information":[{"code":"Px00048110115","type":"CDM"},{"code":"92986","type":"HCPCS"}],"standard_charges":[{"gross_charge":18087.0,"discounted_cash":12660.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12495.0,"discounted_cash":8746.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REVISION OF MITRAL VALVE","code_information":[{"code":"Px00048110116","type":"CDM"},{"code":"92987","type":"HCPCS"}],"standard_charges":[{"gross_charge":17478.0,"discounted_cash":12234.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REVISION OF PULMONARY VALVE","code_information":[{"code":"Px00048110117","type":"CDM"},{"code":"92990","type":"HCPCS"}],"standard_charges":[{"gross_charge":18087.0,"discounted_cash":12660.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12495.0,"discounted_cash":8746.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PUL ART BALLOON REPR PERCUT","code_information":[{"code":"Px00048110122","type":"CDM"},{"code":"92997","type":"HCPCS"}],"standard_charges":[{"gross_charge":12495.0,"discounted_cash":8746.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12495.0,"discounted_cash":8746.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PUL ART BALLOON REPR PERCUT ADDL","code_information":[{"code":"Px00048110123","type":"CDM"},{"code":"92998","type":"HCPCS"}],"standard_charges":[{"gross_charge":13087.0,"discounted_cash":9160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":12367.0,"discounted_cash":8656.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","code_information":[{"code":"Px00048110141","type":"CDM"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":9423.0,"discounted_cash":6596.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8791.0,"discounted_cash":6153.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEFT HRT CATH W/VENTRCLGRPHY","code_information":[{"code":"Px00048110142","type":"CDM"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":13333.0,"discounted_cash":9333.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8701.0,"discounted_cash":6090.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":17464.0,"discounted_cash":12224.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8791.0,"discounted_cash":6153.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":11668.0,"discounted_cash":8167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8791.0,"discounted_cash":6153.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":14240.0,"discounted_cash":9968.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8791.0,"discounted_cash":6153.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":20978.0,"discounted_cash":14684.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8791.0,"discounted_cash":6153.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":23305.0,"discounted_cash":16313.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8701.0,"discounted_cash":6090.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":16854.0,"discounted_cash":11797.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8791.0,"discounted_cash":6153.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":19221.0,"discounted_cash":13454.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8701.0,"discounted_cash":6090.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":20847.0,"discounted_cash":14592.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8791.0,"discounted_cash":6153.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":23177.0,"discounted_cash":16223.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8701.0,"discounted_cash":6090.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE CDM","code_information":[{"code":"Px00048110152","type":"CDM"},{"code":"93462","type":"HCPCS"}],"standard_charges":[{"gross_charge":12191.0,"discounted_cash":8533.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MEDICATION ADMIN & HEMODYNAMIC MEASURMENT","code_information":[{"code":"Px00048110153","type":"CDM"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1852.0,"discounted_cash":1296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EXERCISE W/HEMODYNAMIC MEAS","code_information":[{"code":"Px00048110154","type":"CDM"},{"code":"93464","type":"HCPCS"}],"standard_charges":[{"gross_charge":2657.0,"discounted_cash":1859.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5690.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5690.0,"discounted_cash":3983.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY OF HEART LINING","code_information":[{"code":"Px00048110158","type":"CDM"},{"code":"93505","type":"HCPCS"}],"standard_charges":[{"gross_charge":5632.0,"discounted_cash":3942.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5632.0,"discounted_cash":3942.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECT CONGENITAL CARD CATH","code_information":[{"code":"Px00048110183","type":"CDM"},{"code":"93563","type":"HCPCS"}],"standard_charges":[{"gross_charge":1651.0,"discounted_cash":1155.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2213.0,"discounted_cash":1549.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INJECT L VENTR/ATRIAL ANGIO","code_information":[{"code":"Px00048110185","type":"CDM"},{"code":"93565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2638.0,"discounted_cash":1846.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2607.0,"discounted_cash":1824.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3547.0,"discounted_cash":2482.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4015.0,"discounted_cash":2810.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10376.0,"discounted_cash":7263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"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":9399.0,"discounted_cash":6579.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRANSCATH CLOSURE OF ASD","code_information":[{"code":"Px00048110191","type":"CDM"},{"code":"93580","type":"HCPCS"}],"standard_charges":[{"gross_charge":23583.0,"discounted_cash":16508.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16290.0,"discounted_cash":11403.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRANSCATH CLOSURE OF VSD","code_information":[{"code":"Px00048110192","type":"CDM"},{"code":"93581","type":"HCPCS"}],"standard_charges":[{"gross_charge":35270.0,"discounted_cash":24689.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":16121.0,"discounted_cash":11284.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BUNDLE OF HIS RECORDING","code_information":[{"code":"Px00048110193","type":"CDM"},{"code":"93600","type":"HCPCS"}],"standard_charges":[{"gross_charge":9221.0,"discounted_cash":6454.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRA-ATRIAL RECORDING","code_information":[{"code":"Px00048110194","type":"CDM"},{"code":"93602","type":"HCPCS"}],"standard_charges":[{"gross_charge":9221.0,"discounted_cash":6454.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RIGHT VENTRICULAR RECORDING","code_information":[{"code":"Px00048110195","type":"CDM"},{"code":"93603","type":"HCPCS"}],"standard_charges":[{"gross_charge":9221.0,"discounted_cash":6454.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA","code_information":[{"code":"Px00048110196","type":"CDM"},{"code":"93609","type":"HCPCS"}],"standard_charges":[{"gross_charge":8417.0,"discounted_cash":5891.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INTRA-ATRIAL PACING","code_information":[{"code":"Px00048110197","type":"CDM"},{"code":"93610","type":"HCPCS"}],"standard_charges":[{"gross_charge":9221.0,"discounted_cash":6454.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESOPHAGEAL RECORDING","code_information":[{"code":"Px00048110200","type":"CDM"},{"code":"93615","type":"HCPCS"}],"standard_charges":[{"gross_charge":11132.0,"discounted_cash":7792.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESOPHAGEAL RECORDING W/PACING","code_information":[{"code":"Px00048110201","type":"CDM"},{"code":"93616","type":"HCPCS"}],"standard_charges":[{"gross_charge":11132.0,"discounted_cash":7792.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CARDIOVASCULAR PROCEDURE","code_information":[{"code":"Px00048110210","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":496.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANGIOPLASTY CS","code_information":[{"code":"Px00048110216","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":496.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":331.0,"discounted_cash":231.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC STEM DRUG ESOPH PACING (PEDS)","code_information":[{"code":"Px00048110218","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":496.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANALYZE PACEMAKER SYSTEM","code_information":[{"code":"Px00048110219","type":"CDM"},{"code":"93724","type":"HCPCS"}],"standard_charges":[{"gross_charge":7022.0,"discounted_cash":4915.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ILIAC ART ANGIO,CARDIAC CATH","code_information":[{"code":"Px00048110224","type":"CDM"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2025.0,"discounted_cash":1417.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC OCCLUSIVE DEVICE IN VEIN ART","code_information":[{"code":"Px00048110275","type":"CDM"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":850.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REPLACEMENT PM DUAL LEAD SYSTEM","code_information":[{"code":"Px00048110293","type":"CDM"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":40128.0,"discounted_cash":28089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION ICD GEN ONLY EXISTING MULT LEADS","code_information":[{"code":"Px00048110296","type":"CDM"},{"code":"33231","type":"HCPCS"}],"standard_charges":[{"gross_charge":115768.0,"discounted_cash":81037.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS INITIATION VENO-VENOUS","code_information":[{"code":"Px00048110410","type":"CDM"},{"code":"33946","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS INITIATION VENO-ARTERIAL","code_information":[{"code":"Px00048110411","type":"CDM"},{"code":"33947","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS","code_information":[{"code":"Px00048110412","type":"CDM"},{"code":"33948","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL","code_information":[{"code":"Px00048110413","type":"CDM"},{"code":"33949","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ","code_information":[{"code":"Px00048110414","type":"CDM"},{"code":"33951","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ","code_information":[{"code":"Px00048110415","type":"CDM"},{"code":"33952","type":"HCPCS"}],"standard_charges":[{"gross_charge":1615.0,"discounted_cash":1130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS","code_information":[{"code":"Px00048110420","type":"CDM"},{"code":"33957","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER","code_information":[{"code":"Px00048110421","type":"CDM"},{"code":"33958","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS","code_information":[{"code":"Px00048110426","type":"CDM"},{"code":"33965","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER","code_information":[{"code":"Px00048110427","type":"CDM"},{"code":"33966","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ARTERY EXPOS/GRAFT ARTERY","code_information":[{"code":"Px00048110432","type":"CDM"},{"code":"33987","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC INSERTION OF LEFT HEART VENT","code_information":[{"code":"Px00048110433","type":"CDM"},{"code":"33988","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REMOVAL OF LEFT HEART VENT","code_information":[{"code":"Px00048110434","type":"CDM"},{"code":"33989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":1073.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK MITRAL","code_information":[{"code":"Px00048110435","type":"CDM"},{"code":"93590","type":"HCPCS"}],"standard_charges":[{"gross_charge":62984.0,"discounted_cash":44088.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK AORTIC","code_information":[{"code":"Px00048110436","type":"CDM"},{"code":"93591","type":"HCPCS"}],"standard_charges":[{"gross_charge":62984.0,"discounted_cash":44088.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":31494.0,"discounted_cash":22045.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT","code_information":[{"code":"Px00048110441","type":"CDM"},{"code":"33340","type":"HCPCS"}],"standard_charges":[{"gross_charge":23094.0,"discounted_cash":16165.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1367.0,"discounted_cash":956.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1006.0,"discounted_cash":704.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL CDM","code_information":[{"code":"Px00048300001","type":"CDM"},{"code":"93319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":1092.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2644.0,"discounted_cash":1850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","code_information":[{"code":"Px00048310002","type":"CDM"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1331.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2011.0,"discounted_cash":1407.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH CDM","code_information":[{"code":"Px00048310004","type":"CDM"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD","code_information":[{"code":"Px00048310013","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO STRESS W/INTERP REPT & MONITOR","code_information":[{"code":"Px00048310016","type":"CDM"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":2706.0,"discounted_cash":1894.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST COMPLETE","code_information":[{"code":"Px00048310019","type":"CDM"},{"code":"C8923","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.0,"discounted_cash":1443.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2182.0,"discounted_cash":1527.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TEE W/WO CONTRAST COMPLETE","code_information":[{"code":"Px00048310021","type":"CDM"},{"code":"C8925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2694.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TEE W/WO CONTRAST CONGEN","code_information":[{"code":"Px00048310022","type":"CDM"},{"code":"C8926","type":"HCPCS"}],"standard_charges":[{"gross_charge":2694.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2694.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2694.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECHO TTE W OR W/O FOL W/CONT CONGENITAL LTD","code_information":[{"code":"Px00048310043","type":"CDM"},{"code":"C8922","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.0,"discounted_cash":1443.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYSTOSCOPY","code_information":[{"code":"Px00051010098","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":959.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BIOPSY OF VULVA/PERINEUM","code_information":[{"code":"Px00051010121","type":"CDM"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":1075.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PREVENTIVE COUNSELING INDIV 15 MIN","code_information":[{"code":"Px00051010330","type":"CDM"},{"code":"99401","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PREVENTIVE COUNSELING INDIV 30 MIN","code_information":[{"code":"Px00051010331","type":"CDM"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":231.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PREVENTIVE COUNSELING INDIV 45 MIN","code_information":[{"code":"Px00051010332","type":"CDM"},{"code":"99403","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED CDM","code_information":[{"code":"Px00051010399","type":"CDM"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1071.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ACNE SURGERY  CDM","code_information":[{"code":"Px00051010402","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1  CDM","code_information":[{"code":"Px00051010403","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SHAVING SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM  CDM","code_information":[{"code":"Px00051010408","type":"CDM"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/OR LESS CDM","code_information":[{"code":"Px00051010410","type":"CDM"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":1327.0,"discounted_cash":928.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM CDM","code_information":[{"code":"Px00051010418","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":928.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM CDM","code_information":[{"code":"Px00051010419","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS CDM","code_information":[{"code":"Px00051010424","type":"CDM"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":928.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM  CDM","code_information":[{"code":"Px00051010426","type":"CDM"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":2659.0,"discounted_cash":1861.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DESTRUCTION BENIGN LESIONS UP TO 14  CDM","code_information":[{"code":"Px00051010446","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC  CDM","code_information":[{"code":"Px00051010467","type":"CDM"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.0,"discounted_cash":1954.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC QUAN MR ALYS TIS COMPJ WO MRI SAME SESS MLT ORGN CDM","code_information":[{"code":"Px00061000001","type":"CDM"},{"code":"0697T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1033.0,"discounted_cash":723.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC QUAN MR ALYS TISS COMPOSITION W/MRI MLT ORGANS CDM","code_information":[{"code":"Px00061000002","type":"CDM"},{"code":"0698T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1033.0,"discounted_cash":723.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI QUAN ALYS BRAIN W DX MRI ADD-ON CDM","code_information":[{"code":"Px00061000007","type":"CDM"},{"code":"0866T","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":602.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI IMAGE JAW JOINT TMJ","code_information":[{"code":"Px00061010002","type":"CDM"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":3016.0,"discounted_cash":2111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI ORBIT/FACE/NECK W CONTRAST","code_information":[{"code":"Px00061010005","type":"CDM"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":3660.0,"discounted_cash":2562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI ORBIT/FACE/NECK WO & W CONTRAST","code_information":[{"code":"Px00061010007","type":"CDM"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":5891.0,"discounted_cash":4123.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3591.0,"discounted_cash":2513.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA HEAD WO CONTRAST","code_information":[{"code":"Px00061010009","type":"CDM"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":2523.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2087.0,"discounted_cash":1460.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA HEAD W CONTRAST","code_information":[{"code":"Px00061010010","type":"CDM"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":3649.0,"discounted_cash":2554.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA HEAD WO & W CONTRAST","code_information":[{"code":"Px00061010012","type":"CDM"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":5031.0,"discounted_cash":3521.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3489.0,"discounted_cash":2442.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA NECK WO CONTRAST","code_information":[{"code":"Px00061010013","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":2607.0,"discounted_cash":1824.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2087.0,"discounted_cash":1460.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA NECK W CONTRAST","code_information":[{"code":"Px00061010014","type":"CDM"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":3536.0,"discounted_cash":2475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA NECK WO & W CONTRAST","code_information":[{"code":"Px00061010015","type":"CDM"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":5248.0,"discounted_cash":3673.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3489.0,"discounted_cash":2442.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010019","type":"CDM"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010022","type":"CDM"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":4908.0,"discounted_cash":3435.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CHEST WO & W CONTRAST","code_information":[{"code":"Px00061010025","type":"CDM"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":7121.0,"discounted_cash":4984.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2974.0,"discounted_cash":2081.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI PELVIS WO CONTRAST","code_information":[{"code":"Px00061010029","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":3533.0,"discounted_cash":2473.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI PELVIS W CONTRAST","code_information":[{"code":"Px00061010038","type":"CDM"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":4090.0,"discounted_cash":2863.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061010044","type":"CDM"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":6965.0,"discounted_cash":4875.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2889.0,"discounted_cash":2022.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010053","type":"CDM"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":7116.0,"discounted_cash":4981.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2974.0,"discounted_cash":2081.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010054","type":"CDM"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":3588.0,"discounted_cash":2511.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT W CONTRAST","code_information":[{"code":"Px00061010057","type":"CDM"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":4090.0,"discounted_cash":2863.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010059","type":"CDM"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5835.0,"discounted_cash":4084.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2889.0,"discounted_cash":2022.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010063","type":"CDM"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3859.0,"discounted_cash":2701.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1780.0,"discounted_cash":1246.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010065","type":"CDM"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":3748.0,"discounted_cash":2623.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010066","type":"CDM"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":4848.0,"discounted_cash":3393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010068","type":"CDM"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":5858.0,"discounted_cash":4100.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2889.0,"discounted_cash":2022.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010075","type":"CDM"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3834.0,"discounted_cash":2683.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1780.0,"discounted_cash":1246.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010077","type":"CDM"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4417.0,"discounted_cash":3091.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010079","type":"CDM"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":5871.0,"discounted_cash":4109.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2889.0,"discounted_cash":2022.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI MRCP ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010082","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":4283.0,"discounted_cash":2998.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010083","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":4283.0,"discounted_cash":2998.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI ABDOMEN W CONTRAST","code_information":[{"code":"Px00061010085","type":"CDM"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":5461.0,"discounted_cash":3822.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI ABDOMEN WO & W CONTRAST","code_information":[{"code":"Px00061010087","type":"CDM"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":8938.0,"discounted_cash":6256.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2974.0,"discounted_cash":2081.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CARDIAC FOR MORPH","code_information":[{"code":"Px00061010090","type":"CDM"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.0,"discounted_cash":1851.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CARDIAC W/STRESS IMG","code_information":[{"code":"Px00061010091","type":"CDM"},{"code":"75559","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.0,"discounted_cash":1851.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CARDIAC FOR MORPH W/WO DYE","code_information":[{"code":"Px00061010092","type":"CDM"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":3397.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2974.0,"discounted_cash":2081.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CARDIAC W/STRESS IMG & DYE","code_information":[{"code":"Px00061010093","type":"CDM"},{"code":"75563","type":"HCPCS"}],"standard_charges":[{"gross_charge":4649.0,"discounted_cash":3254.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":6766.0,"discounted_cash":4736.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CARDIAC VELOC FLOW MAPPING","code_information":[{"code":"Px00061010094","type":"CDM"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":273.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI SPECTROSCOPY","code_information":[{"code":"Px00061010095","type":"CDM"},{"code":"76390","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":2014.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2909.0,"discounted_cash":2036.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI BONE MARROW BLOOD SUPPLY","code_information":[{"code":"Px00061010100","type":"CDM"},{"code":"77084","type":"HCPCS"}],"standard_charges":[{"gross_charge":3870.0,"discounted_cash":2709.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010114","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6167.0,"discounted_cash":4316.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6167.0,"discounted_cash":4316.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6167.0,"discounted_cash":4316.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2905.0,"discounted_cash":2033.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2905.0,"discounted_cash":2033.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2905.0,"discounted_cash":2033.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRA W/CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010123","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":4600.0,"discounted_cash":3220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA W/O CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010124","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":4408.0,"discounted_cash":3085.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5548.0,"discounted_cash":3883.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2889.0,"discounted_cash":2022.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI UPPER EXTREMITY W/DYE","code_information":[{"code":"Px00061010137","type":"CDM"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":4090.0,"discounted_cash":2863.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI PROCEDURE UNLISTED","code_information":[{"code":"Px00061010139","type":"CDM"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3402.0,"discounted_cash":2381.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2087.0,"discounted_cash":1460.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010143","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6314.0,"discounted_cash":4419.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6314.0,"discounted_cash":4419.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6314.0,"discounted_cash":4419.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2889.0,"discounted_cash":2022.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MR ANGIO PELVIS W/O DYE","code_information":[{"code":"Px00061010148","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3471.0,"discounted_cash":2429.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3471.0,"discounted_cash":2429.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1874.0,"discounted_cash":1311.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5403.0,"discounted_cash":3782.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W/DYE","code_information":[{"code":"Px00061010238","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5175.0,"discounted_cash":3622.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4544.0,"discounted_cash":3180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI FETAL SNGL/1ST GESTATION","code_information":[{"code":"Px00061010256","type":"CDM"},{"code":"74712","type":"HCPCS"}],"standard_charges":[{"gross_charge":3925.0,"discounted_cash":2747.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI FETAL EA ADDL GESTATION","code_information":[{"code":"Px00061010257","type":"CDM"},{"code":"74713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.0,"discounted_cash":1374.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3547.0,"discounted_cash":2482.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2150.0,"discounted_cash":1505.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI BRAIN W/O DYE LIMITED","code_information":[{"code":"Px00061110002","type":"CDM"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2209.0,"discounted_cash":1546.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE","code_information":[{"code":"Px00061110007","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3704.0,"discounted_cash":2592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI BRAIN W/DYE W/FIDUCIAL MRKRS","code_information":[{"code":"Px00061110010","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3704.0,"discounted_cash":2592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI BRAIN W/DYE W/O FIDUCIAL MRKRS","code_information":[{"code":"Px00061110011","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3704.0,"discounted_cash":2592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI BRAIN W/O & W/DYE","code_information":[{"code":"Px00061110015","type":"CDM"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":6035.0,"discounted_cash":4224.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3591.0,"discounted_cash":2513.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE","code_information":[{"code":"Px00061210001","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2087.0,"discounted_cash":1460.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210002","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.0,"discounted_cash":641.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/DYE","code_information":[{"code":"Px00061210003","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3476.0,"discounted_cash":2433.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/DYE LIMITED","code_information":[{"code":"Px00061210004","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":1435.0,"discounted_cash":1004.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI THORACIC SPINE W/O DYE","code_information":[{"code":"Px00061210005","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":3914.0,"discounted_cash":2739.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI THORACIC SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210006","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.0,"discounted_cash":1862.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/DYE","code_information":[{"code":"Px00061210007","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":3972.0,"discounted_cash":2780.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI THORACIC SPINE W/DYE LIMITED","code_information":[{"code":"Px00061210008","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":1515.0,"discounted_cash":1060.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4241.0,"discounted_cash":2968.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1780.0,"discounted_cash":1246.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210010","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":924.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/DYE","code_information":[{"code":"Px00061210011","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4524.0,"discounted_cash":3166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LUMBAR SPINE W/DYE LIMITED","code_information":[{"code":"Px00061210012","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":1616.0,"discounted_cash":1131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE","code_information":[{"code":"Px00061210013","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":5420.0,"discounted_cash":3794.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3591.0,"discounted_cash":2513.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE LIMITED","code_information":[{"code":"Px00061210014","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":1651.0,"discounted_cash":1155.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6164.0,"discounted_cash":4314.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2974.0,"discounted_cash":2081.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LUMBAR SPINE W/O & W/DYE","code_information":[{"code":"Px00061210017","type":"CDM"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":7291.0,"discounted_cash":5103.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2974.0,"discounted_cash":2081.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MRI LUMBAR SPINE W/O & W/DYE LIMITED","code_information":[{"code":"Px00061210018","type":"CDM"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":3680.0,"discounted_cash":2576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MRA PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061210028","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":6167.0,"discounted_cash":4316.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MR ANGIO PELVIS W/DYE","code_information":[{"code":"Px00061810001","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3989.0,"discounted_cash":2792.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX BENRALIZUMAB INJ 1 MG","code_information":[{"code":"Px00063600022","type":"CDM"},{"code":"J0517","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA","code_information":[{"code":"Px00063600095","type":"CDM"},{"code":"90677","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":417.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX INCLISIRAN INJ 1 MG","code_information":[{"code":"Px00063600109","type":"CDM"},{"code":"J1306","type":"HCPCS"}],"standard_charges":[{"gross_charge":8125.0,"discounted_cash":5687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC PR RX TEZEPELUMAB-EKKO INJ 1 MG","code_information":[{"code":"Px00063600114","type":"CDM"},{"code":"J2356","type":"HCPCS"}],"standard_charges":[{"gross_charge":9083.0,"discounted_cash":6358.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC PR RX VUTRISIRAN 1 MG INJ","code_information":[{"code":"Px00063600142","type":"CDM"},{"code":"J0225","type":"HCPCS"}],"standard_charges":[{"gross_charge":9548.0,"discounted_cash":6683.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH 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: WSH 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: WSH 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: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX CANAKINUMAB INJ 1 MG","code_information":[{"code":"Px00063600174","type":"CDM"},{"code":"J0638","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX LUMASIRAN INJ 0.5 MG","code_information":[{"code":"Px00063600177","type":"CDM"},{"code":"J0224","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX BUROSUMAB-TWZA INJ 1MG","code_information":[{"code":"Px00063600246","type":"CDM"},{"code":"J0584","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":802.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX EPOETIN NON ESRD INJ 1000 UNITS","code_information":[{"code":"Px00063600260","type":"CDM"},{"code":"J0885","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML","code_information":[{"code":"Px00063610038","type":"CDM"},{"code":"90714","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX HEPATITIS A & B VACCINE ADULT IM 1 ML","code_information":[{"code":"Px00063610044","type":"CDM"},{"code":"90636","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML","code_information":[{"code":"Px00063610056","type":"CDM"},{"code":"90715","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX PNEUMOCOCCAL VACCINE 23 VALENT 2 YRS OR OLDER SQ/IM 0.5","code_information":[{"code":"Px00063610058","type":"CDM"},{"code":"90732","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX RABIES VACCINE IM 1 ML","code_information":[{"code":"Px00063610067","type":"CDM"},{"code":"90675","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.5 ML","code_information":[{"code":"Px00063610082","type":"CDM"},{"code":"90686","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX INFLUENZA TRIVALENT CCIIV3 ANTIBIOTIC FREE IM 0.5 ML","code_information":[{"code":"Px00063610085","type":"CDM"},{"code":"90661","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX PNEUMOCOCCAL VACCINE 13 VALENT IM 0.5 ML","code_information":[{"code":"Px00063610093","type":"CDM"},{"code":"90670","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML","code_information":[{"code":"Px00063610107","type":"CDM"},{"code":"90653","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX ZOSTER VACCINE HZV LIVE SQ 0.65 ML","code_information":[{"code":"Px00063610129","type":"CDM"},{"code":"90736","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX CERTOLIZUMAB PEGOL INJ 1 MG","code_information":[{"code":"Px00063610133","type":"CDM"},{"code":"J0717","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX DENOSUMAB INJ 1 MG","code_information":[{"code":"Px00063610134","type":"CDM"},{"code":"J0897","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX VITAMIN B12 INJ 1000 MCG","code_information":[{"code":"Px00063610135","type":"CDM"},{"code":"J3420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC METHYLENE BLUE INJ","code_information":[{"code":"Px00063610144","type":"CDM"},{"code":"Q9968","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX RHO D IMMUNE GLOBULIN INJ 300 MCG (1500 IU)","code_information":[{"code":"Px00063610194","type":"CDM"},{"code":"J2790","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":599.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX INFLUENZA QUADRIVALENT (RIV4) PF IM 0.5 ML","code_information":[{"code":"Px00063610235","type":"CDM"},{"code":"90682","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX OMALIZUMAB INJ 5 MG","code_information":[{"code":"Px00063610264","type":"CDM"},{"code":"J2357","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML","code_information":[{"code":"Px00063610299","type":"CDM"},{"code":"90746","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML","code_information":[{"code":"Px00063610304","type":"CDM"},{"code":"90656","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML","code_information":[{"code":"Px00063610313","type":"CDM"},{"code":"90632","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX USTEKINUMAB SQ INJ 1 MG","code_information":[{"code":"Px00063610326","type":"CDM"},{"code":"J3357","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX TILDRAKIZUMAB-ASMN INJ 1 MG","code_information":[{"code":"Px00063610518","type":"CDM"},{"code":"J3245","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":268.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX MEPOLIZUMAB INJ 1 MG","code_information":[{"code":"Px00063610519","type":"CDM"},{"code":"J2182","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX ROMOSOZUMAB-AQQG INJ 1 MG","code_information":[{"code":"Px00063610520","type":"CDM"},{"code":"J3111","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR RX LIDOCAINE HCL INJ 10 MG","code_information":[{"code":"Px00063610531","type":"CDM"},{"code":"J2002","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15303.0,"discounted_cash":10712.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION PARTIAL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210002","type":"CDM"}],"standard_charges":[{"gross_charge":4436.0,"discounted_cash":3105.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION FULL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210104","type":"CDM"}],"standard_charges":[{"gross_charge":4436.0,"discounted_cash":3105.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20404.0,"discounted_cash":14282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL","code_information":[{"code":"Px00071010127","type":"CDM"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL 15","code_information":[{"code":"Px00071010131","type":"CDM"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 INITIAL 15","code_information":[{"code":"Px00071010132","type":"CDM"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 INITIAL 15","code_information":[{"code":"Px00071010133","type":"CDM"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 INITIAL 15","code_information":[{"code":"Px00071010134","type":"CDM"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":515.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 INITIAL 15","code_information":[{"code":"Px00071010135","type":"CDM"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 PER MIN","code_information":[{"code":"Px00071010231","type":"CDM"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 PER MIN","code_information":[{"code":"Px00071010232","type":"CDM"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 PER MIN","code_information":[{"code":"Px00071010233","type":"CDM"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 PER MIN","code_information":[{"code":"Px00071010234","type":"CDM"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 PER MIN","code_information":[{"code":"Px00071010358","type":"CDM"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CERCLAGE CERVIX PREGNANCY VAGINAL CDM","code_information":[{"code":"Px00072010001","type":"CDM"},{"code":"59320","type":"HCPCS"}],"standard_charges":[{"gross_charge":9300.0,"discounted_cash":6510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANTE ACUITY PER HR CLASS 1","code_information":[{"code":"Px00072010067","type":"CDM"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 1 CDM","code_information":[{"code":"Px00072210001","type":"CDM"}],"standard_charges":[{"gross_charge":20196.0,"discounted_cash":14137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 2 CDM","code_information":[{"code":"Px00072210002","type":"CDM"}],"standard_charges":[{"gross_charge":23369.0,"discounted_cash":16358.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 3 CDM","code_information":[{"code":"Px00072210003","type":"CDM"}],"standard_charges":[{"gross_charge":26687.0,"discounted_cash":18680.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 4 CDM","code_information":[{"code":"Px00072210004","type":"CDM"}],"standard_charges":[{"gross_charge":29572.0,"discounted_cash":20700.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CIRCUMCISION","code_information":[{"code":"Px00072310003","type":"CDM"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1000.0,"discounted_cash":700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECG 12 LEAD TRACING ONLY","code_information":[{"code":"Px00073010002","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC RHYTHM ECG TRACING ONLY","code_information":[{"code":"Px00073010003","type":"CDM"},{"code":"93041","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":222.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HOLTER MONITOR ANALYSIS & REPT","code_information":[{"code":"Px00073110002","type":"CDM"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":653.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":290.0,"discounted_cash":203.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EEG EXTENDED MONITORING 41-60 MINUTES","code_information":[{"code":"Px00074010013","type":"CDM"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":2456.0,"discounted_cash":1719.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":744.0,"discounted_cash":520.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EEG EXTENDED MONITORING 61-119 MINUTES","code_information":[{"code":"Px00074010014","type":"CDM"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1834.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":744.0,"discounted_cash":520.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","code_information":[{"code":"Px00074010015","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1831.0,"discounted_cash":1281.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":744.0,"discounted_cash":520.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00074010018","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2351.0,"discounted_cash":1645.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":744.0,"discounted_cash":520.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EEG COMA OR SLEEP ONLY","code_information":[{"code":"Px00074010020","type":"CDM"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1416.0,"discounted_cash":991.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":744.0,"discounted_cash":520.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EEG CEREBRAL DEATH ONLY","code_information":[{"code":"Px00074010022","type":"CDM"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":886.0,"discounted_cash":620.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SURGERY ELECTROCORTICOGRAM","code_information":[{"code":"Px00074010026","type":"CDM"},{"code":"95829","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":669.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EEG PEDIATRIC/NEONATAL AWAKE & ASLEEP","code_information":[{"code":"Px00074010038","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2351.0,"discounted_cash":1645.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":744.0,"discounted_cash":520.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EEG- SSEP UPPERS & LOWERS","code_information":[{"code":"Px00074010044","type":"CDM"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":564.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC MOTOR EVOKED UPR&LWR LIMBS","code_information":[{"code":"Px00074010045","type":"CDM"},{"code":"95939","type":"HCPCS"}],"standard_charges":[{"gross_charge":4822.0,"discounted_cash":3375.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1051.0,"discounted_cash":735.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":859.0,"discounted_cash":601.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS R-T MNTR CDM","code_information":[{"code":"Px00074010060","type":"CDM"},{"code":"95707","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2016.0,"discounted_cash":1411.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR CDM","code_information":[{"code":"Px00074010062","type":"CDM"},{"code":"95709","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.0,"discounted_cash":1108.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HOURS UNMONITORED CDM","code_information":[{"code":"Px00074010064","type":"CDM"},{"code":"95711","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":735.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING CDM","code_information":[{"code":"Px00074010065","type":"CDM"},{"code":"95712","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":735.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING CDM","code_information":[{"code":"Px00074010066","type":"CDM"},{"code":"95713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1411.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR UNMONITORED CDM","code_information":[{"code":"Px00074010067","type":"CDM"},{"code":"95714","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1411.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR CDM","code_information":[{"code":"Px00074010068","type":"CDM"},{"code":"95715","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1411.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR CONT R-T MNTR CDM","code_information":[{"code":"Px00074010069","type":"CDM"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":3775.0,"discounted_cash":2642.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ECOG IMPLANTED BRAIN NPGT W/REC R&I/ UP TO 30 DAYS","code_information":[{"code":"Px00074010082","type":"CDM"},{"code":"95836","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC C MOTOR EVOKED UPPR LIMBS","code_information":[{"code":"Px00074010106","type":"CDM"},{"code":"95928","type":"HCPCS"}],"standard_charges":[{"gross_charge":4822.0,"discounted_cash":3375.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC C MOTOR EVOKED LWR LIMBS","code_information":[{"code":"Px00074010107","type":"CDM"},{"code":"95929","type":"HCPCS"}],"standard_charges":[{"gross_charge":2577.0,"discounted_cash":1803.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EEG DURING SURGERY","code_information":[{"code":"Px00074010115","type":"CDM"},{"code":"95955","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":797.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EEG DIGITAL ANALYSIS","code_information":[{"code":"Px00074010118","type":"CDM"},{"code":"95957","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EEG MONITORING/FUNCTION TEST","code_information":[{"code":"Px00074010119","type":"CDM"},{"code":"95958","type":"HCPCS"}],"standard_charges":[{"gross_charge":4405.0,"discounted_cash":3083.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3639.0,"discounted_cash":2547.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR","code_information":[{"code":"Px00074010120","type":"CDM"},{"code":"95961","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":611.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":715.0,"discounted_cash":500.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTRODE STIM BRAIN ADD-ON","code_information":[{"code":"Px00074010121","type":"CDM"},{"code":"95962","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ANORECTAL MANOMETRY","code_information":[{"code":"Px00075010001","type":"CDM"},{"code":"91122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":1195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1095.0,"discounted_cash":766.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BREATH HYDROGEN TEST","code_information":[{"code":"Px00075010003","type":"CDM"},{"code":"91065","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":760.0,"discounted_cash":532.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHOLANGIOSCOPY","code_information":[{"code":"Px00075010009","type":"CDM"}],"standard_charges":[{"gross_charge":13544.0,"discounted_cash":9480.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLON DBL BALLON ENTEROSCOPY","code_information":[{"code":"Px00075010010","type":"CDM"}],"standard_charges":[{"gross_charge":5482.0,"discounted_cash":3837.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY SCREENING","code_information":[{"code":"Px00075010014","type":"CDM"}],"standard_charges":[{"gross_charge":3426.0,"discounted_cash":2398.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ BIOPSY","code_information":[{"code":"Px00075010015","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY W/ BLEEDING CONT","code_information":[{"code":"Px00075010016","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLOREC SCREEN HIGH RISK","code_information":[{"code":"Px00075010020","type":"CDM"}],"standard_charges":[{"gross_charge":4648.0,"discounted_cash":3253.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4015.0,"discounted_cash":2810.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLOREC SCREEN LOW RISK","code_information":[{"code":"Px00075010021","type":"CDM"}],"standard_charges":[{"gross_charge":4648.0,"discounted_cash":3253.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4015.0,"discounted_cash":2810.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD DBL BALLOON ENTEROSCOPY","code_information":[{"code":"Px00075010022","type":"CDM"}],"standard_charges":[{"gross_charge":7385.0,"discounted_cash":5169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"Px00075010024","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD CONTROL BLEEDING ANY","code_information":[{"code":"Px00075010025","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD W/ FOREIGN BODY REMOVAL","code_information":[{"code":"Px00075010026","type":"CDM"}],"standard_charges":[{"gross_charge":5173.0,"discounted_cash":3621.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENTEROSCOPY","code_information":[{"code":"Px00075010032","type":"CDM"}],"standard_charges":[{"gross_charge":7604.0,"discounted_cash":5322.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5097.0,"discounted_cash":3567.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ERCP","code_information":[{"code":"Px00075010033","type":"CDM"}],"standard_charges":[{"gross_charge":12448.0,"discounted_cash":8713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10750.0,"discounted_cash":7525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ERCP W SPHINCTEROTOMY","code_information":[{"code":"Px00075010035","type":"CDM"}],"standard_charges":[{"gross_charge":4683.0,"discounted_cash":3278.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGEAL MANOMETRY","code_information":[{"code":"Px00075010037","type":"CDM"},{"code":"91010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2215.0,"discounted_cash":1550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1681.0,"discounted_cash":1176.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EUS LINEAR","code_information":[{"code":"Px00075010040","type":"CDM"}],"standard_charges":[{"gross_charge":5491.0,"discounted_cash":3843.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FLEXIBLE SIGMOIDOSCOPY W/ BIOPOSY","code_information":[{"code":"Px00075010046","type":"CDM"}],"standard_charges":[{"gross_charge":3309.0,"discounted_cash":2316.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED GASTEROENTOLOGY PROCEDURE","code_information":[{"code":"Px00075010049","type":"CDM"},{"code":"91299","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":760.0,"discounted_cash":532.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GASTROESOPHAGEAL REFLUX TEST","code_information":[{"code":"Px00075010050","type":"CDM"},{"code":"91034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2198.0,"discounted_cash":1538.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1337.0,"discounted_cash":935.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC G-ESOPH REFLUX TEST","code_information":[{"code":"Px00075010054","type":"CDM"},{"code":"91035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.0,"discounted_cash":1052.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GI TRACT CAPSULE ENDOSCOPY","code_information":[{"code":"Px00075010056","type":"CDM"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2286.0,"discounted_cash":1600.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IRC TREATMENT","code_information":[{"code":"Px00075010058","type":"CDM"}],"standard_charges":[{"gross_charge":3388.0,"discounted_cash":2371.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2926.0,"discounted_cash":2048.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED ENDO PROCEDURE","code_information":[{"code":"Px00075010063","type":"CDM"}],"standard_charges":[{"gross_charge":5173.0,"discounted_cash":3621.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PH MONITOR 24 HR","code_information":[{"code":"Px00075010068","type":"CDM"},{"code":"91034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2198.0,"discounted_cash":1538.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1337.0,"discounted_cash":935.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PUDENDAL NERVE MONITOR PROC","code_information":[{"code":"Px00075010071","type":"CDM"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":671.0,"discounted_cash":469.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY RIGID","code_information":[{"code":"Px00075010073","type":"CDM"}],"standard_charges":[{"gross_charge":3427.0,"discounted_cash":2398.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UPPR GI SCOPE W/SUBMUC INJ","code_information":[{"code":"Px00075010084","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD W/ ABLATION","code_information":[{"code":"Px00075010085","type":"CDM"}],"standard_charges":[{"gross_charge":3995.0,"discounted_cash":2796.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD VARICES LIGATION","code_information":[{"code":"Px00075010086","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD GUIDE WIRE INSERTION","code_information":[{"code":"Px00075010087","type":"CDM"}],"standard_charges":[{"gross_charge":3606.0,"discounted_cash":2524.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"Px00075010088","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD W/ REMOVAL OF FB","code_information":[{"code":"Px00075010089","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENTERO JEJUNUM SNARE","code_information":[{"code":"Px00075010090","type":"CDM"}],"standard_charges":[{"gross_charge":8641.0,"discounted_cash":6048.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7464.0,"discounted_cash":5224.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CHANGE GASTROSTOMY TUBE","code_information":[{"code":"Px00075010097","type":"CDM"}],"standard_charges":[{"gross_charge":2558.0,"discounted_cash":1790.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY POLP/HOT BX","code_information":[{"code":"Px00075010098","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY POLYP SNARE","code_information":[{"code":"Px00075010099","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY THRU STOMA","code_information":[{"code":"Px00075010100","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY W/ SUBMUC INJ","code_information":[{"code":"Px00075010101","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010102","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DILAT ANAL SPHNCTER A/ANESTH","code_information":[{"code":"Px00075010104","type":"CDM"}],"standard_charges":[{"gross_charge":10178.0,"discounted_cash":7124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":8789.0,"discounted_cash":6152.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"Px00075010106","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD DILATE STRICTURE","code_information":[{"code":"Px00075010107","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESOPH EGD DILATION/LESS THAN 30 MM","code_information":[{"code":"Px00075010108","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD INJ SCLEROS VARICES","code_information":[{"code":"Px00075010109","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ERCP WITH BIOPSY","code_information":[{"code":"Px00075010110","type":"CDM"}],"standard_charges":[{"gross_charge":12448.0,"discounted_cash":8713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10750.0,"discounted_cash":7525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMORRHOID INT BANDING","code_information":[{"code":"Px00075010111","type":"CDM"}],"standard_charges":[{"gross_charge":3388.0,"discounted_cash":2371.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2926.0,"discounted_cash":2048.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY DX PROCURE","code_information":[{"code":"Px00075010113","type":"CDM"}],"standard_charges":[{"gross_charge":3309.0,"discounted_cash":2316.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010114","type":"CDM"}],"standard_charges":[{"gross_charge":5451.0,"discounted_cash":3815.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4709.0,"discounted_cash":3296.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY W/ BALLOON DILATION","code_information":[{"code":"Px00075010115","type":"CDM"}],"standard_charges":[{"gross_charge":5451.0,"discounted_cash":3815.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4709.0,"discounted_cash":3296.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY W/ DIR SUBMUC INJ","code_information":[{"code":"Px00075010116","type":"CDM"}],"standard_charges":[{"gross_charge":3309.0,"discounted_cash":2316.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY W/ REMOVAL FB","code_information":[{"code":"Px00075010117","type":"CDM"}],"standard_charges":[{"gross_charge":5451.0,"discounted_cash":3815.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4709.0,"discounted_cash":3296.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY W/ SNARE REMOVAL","code_information":[{"code":"Px00075010118","type":"CDM"}],"standard_charges":[{"gross_charge":5451.0,"discounted_cash":3815.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4709.0,"discounted_cash":3296.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC UNLISTED PROC INTESTINE","code_information":[{"code":"Px00075010120","type":"CDM"}],"standard_charges":[{"gross_charge":12871.0,"discounted_cash":9009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":11116.0,"discounted_cash":7781.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENTEROSCOPY W/ BIOPSYJEJUNUM","code_information":[{"code":"Px00075010121","type":"CDM"}],"standard_charges":[{"gross_charge":6312.0,"discounted_cash":4418.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5097.0,"discounted_cash":3567.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ERCP W/ REMOVAL CALCULUS","code_information":[{"code":"Px00075010123","type":"CDM"}],"standard_charges":[{"gross_charge":12448.0,"discounted_cash":8713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10750.0,"discounted_cash":7525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ERCP W/ SPHINCTER/PAPILLO","code_information":[{"code":"Px00075010124","type":"CDM"}],"standard_charges":[{"gross_charge":12448.0,"discounted_cash":8713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10750.0,"discounted_cash":7525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESOPHAGUS SCOPE W/SUBMUCOUS INJ","code_information":[{"code":"Px00075010132","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESOPHAGOSCOPY FLEX BIOPSY","code_information":[{"code":"Px00075010133","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESOPH ENDO DILATION BALLOON/LESS THAN 30 MM","code_information":[{"code":"Px00075010134","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD TUBE/CATH INSERTION","code_information":[{"code":"Px00075010137","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD CAUTERY TUMOR POLYP","code_information":[{"code":"Px00075010141","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC EGD REMOVE LESION SNARE","code_information":[{"code":"Px00075010142","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ENDO CHOLANGIOPANCREATOGRAPH W/ LITHOTRIPSY","code_information":[{"code":"Px00075010149","type":"CDM"}],"standard_charges":[{"gross_charge":12448.0,"discounted_cash":8713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":10750.0,"discounted_cash":7525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DILATE ESOPHAGUS, UNGUIDED","code_information":[{"code":"Px00075010154","type":"CDM"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":3363.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4150.0,"discounted_cash":2905.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DILATE ESOPHAGUS, OVER GUIDE WIRE","code_information":[{"code":"Px00075010155","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PRESSURE TREATMENT ESOPHAGUS","code_information":[{"code":"Px00075010157","type":"CDM"}],"standard_charges":[{"gross_charge":3616.0,"discounted_cash":2531.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC BIOPSY OF BOWEL","code_information":[{"code":"Px00075010158","type":"CDM"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":4697.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5797.0,"discounted_cash":4057.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ FB REMOVAL","code_information":[{"code":"Px00075010161","type":"CDM"}],"standard_charges":[{"gross_charge":5902.0,"discounted_cash":4131.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5097.0,"discounted_cash":3567.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ HOT BIOPSY","code_information":[{"code":"Px00075010163","type":"CDM"}],"standard_charges":[{"gross_charge":8641.0,"discounted_cash":6048.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7464.0,"discounted_cash":5224.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ BLEED CONTROL","code_information":[{"code":"Px00075010164","type":"CDM"}],"standard_charges":[{"gross_charge":8641.0,"discounted_cash":6048.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7464.0,"discounted_cash":5224.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ TUBE PLACEMENT","code_information":[{"code":"Px00075010165","type":"CDM"}],"standard_charges":[{"gross_charge":8641.0,"discounted_cash":6048.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7464.0,"discounted_cash":5224.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, CONVERT J-TUBE","code_information":[{"code":"Px00075010166","type":"CDM"}],"standard_charges":[{"gross_charge":8641.0,"discounted_cash":6048.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":7464.0,"discounted_cash":5224.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, ILEOSCOPY","code_information":[{"code":"Px00075010167","type":"CDM"}],"standard_charges":[{"gross_charge":5902.0,"discounted_cash":4131.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5097.0,"discounted_cash":3567.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, ILEOSCOPY W/ BIOPSY","code_information":[{"code":"Px00075010168","type":"CDM"}],"standard_charges":[{"gross_charge":5902.0,"discounted_cash":4131.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5097.0,"discounted_cash":3567.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY THROUGH STOMA","code_information":[{"code":"Px00075010170","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY FOR FOREIGN BODY","code_information":[{"code":"Px00075010171","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY FOR BLEEDING","code_information":[{"code":"Px00075010172","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY & POLYPECTOMY","code_information":[{"code":"Px00075010173","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY W/SNARE","code_information":[{"code":"Px00075010174","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY & POLYPECTOMY","code_information":[{"code":"Px00075010178","type":"CDM"}],"standard_charges":[{"gross_charge":3309.0,"discounted_cash":2316.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2859.0,"discounted_cash":2001.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SIGMOIDOSCOPY & DECOMPRESS","code_information":[{"code":"Px00075010182","type":"CDM"}],"standard_charges":[{"gross_charge":5451.0,"discounted_cash":3815.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4709.0,"discounted_cash":3296.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COLONOSCOPY W/FB REMOVAL","code_information":[{"code":"Px00075010185","type":"CDM"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3701.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4568.0,"discounted_cash":3197.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NDO RECTAL ULTRASOUND PROCEDURE","code_information":[{"code":"Px00075010189","type":"CDM"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":1234.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ESPHGSC W/OPTICAL ENDOMICROSCOPY","code_information":[{"code":"Px00075010203","type":"CDM"}],"standard_charges":[{"gross_charge":3774.0,"discounted_cash":2641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD OPTICAL ENDOMICROSCOPY","code_information":[{"code":"Px00075010204","type":"CDM"}],"standard_charges":[{"gross_charge":3774.0,"discounted_cash":2641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER","code_information":[{"code":"Px00075010206","type":"CDM"},{"code":"52287","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":1230.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","code_information":[{"code":"Px00075010207","type":"CDM"},{"code":"91112","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":516.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY DILATE STRICTURE","code_information":[{"code":"Px00075010211","type":"CDM"}],"standard_charges":[{"gross_charge":4035.0,"discounted_cash":2824.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGOSCP RIG TRNSO REM FB","code_information":[{"code":"Px00075010222","type":"CDM"}],"standard_charges":[{"gross_charge":5450.0,"discounted_cash":3815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY RIGID BALLOON","code_information":[{"code":"Px00075010223","type":"CDM"}],"standard_charges":[{"gross_charge":5450.0,"discounted_cash":3815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY FLEX DX BRUSH","code_information":[{"code":"Px00075010225","type":"CDM"}],"standard_charges":[{"gross_charge":5173.0,"discounted_cash":3621.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGOSC DILATE BALLOON 30","code_information":[{"code":"Px00075010230","type":"CDM"}],"standard_charges":[{"gross_charge":3774.0,"discounted_cash":2641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY LESION ABLATE","code_information":[{"code":"Px00075010231","type":"CDM"}],"standard_charges":[{"gross_charge":11224.0,"discounted_cash":7856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD BALLOON DIL ESOPH30 MM/>","code_information":[{"code":"Px00075010232","type":"CDM"}],"standard_charges":[{"gross_charge":3774.0,"discounted_cash":2641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD US TRANSMURAL INJXN/MARK","code_information":[{"code":"Px00075010233","type":"CDM"}],"standard_charges":[{"gross_charge":5775.0,"discounted_cash":4042.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD ENDO MUCOSAL RESECTION","code_information":[{"code":"Px00075010234","type":"CDM"}],"standard_charges":[{"gross_charge":4591.0,"discounted_cash":3213.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD ENDOSCOPIC STENT PLACE","code_information":[{"code":"Px00075010235","type":"CDM"}],"standard_charges":[{"gross_charge":13791.0,"discounted_cash":9653.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD LESION ABLATION","code_information":[{"code":"Px00075010236","type":"CDM"}],"standard_charges":[{"gross_charge":3774.0,"discounted_cash":2641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ERCP DUCT STENT PLACEMENT","code_information":[{"code":"Px00075010237","type":"CDM"}],"standard_charges":[{"gross_charge":11247.0,"discounted_cash":7872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ERCP REMOVE FORGN BODY DUCT","code_information":[{"code":"Px00075010238","type":"CDM"}],"standard_charges":[{"gross_charge":11247.0,"discounted_cash":7872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ERCP STENT EXCHANGE W/DILATE","code_information":[{"code":"Px00075010239","type":"CDM"}],"standard_charges":[{"gross_charge":11247.0,"discounted_cash":7872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ERCP EA DUCT/AMPULLA DILATE","code_information":[{"code":"Px00075010240","type":"CDM"}],"standard_charges":[{"gross_charge":11247.0,"discounted_cash":7872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOSCOPY OF BOWEL POUCH","code_information":[{"code":"Px00075010242","type":"CDM"}],"standard_charges":[{"gross_charge":5482.0,"discounted_cash":3837.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD EXAM DUODENUM/JEJUNUM","code_information":[{"code":"Px00075010243","type":"CDM"}],"standard_charges":[{"gross_charge":5450.0,"discounted_cash":3815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY","code_information":[{"code":"Px00075010244","type":"CDM"}],"standard_charges":[{"gross_charge":6634.0,"discounted_cash":4643.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOSCOPIC US EXAM ESOPH","code_information":[{"code":"Px00075010245","type":"CDM"}],"standard_charges":[{"gross_charge":5450.0,"discounted_cash":3815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY W STENT PLCMNT","code_information":[{"code":"Px00075010246","type":"CDM"}],"standard_charges":[{"gross_charge":5911.0,"discounted_cash":4137.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY WITH ABLATION THROUGH STOMA","code_information":[{"code":"Px00075010247","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/STENT PLCMT THROUGH STOMA","code_information":[{"code":"Px00075010248","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/RESECTION","code_information":[{"code":"Px00075010249","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/INJECTION","code_information":[{"code":"Px00075010250","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DILATION","code_information":[{"code":"Px00075010251","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ULTRASOUND","code_information":[{"code":"Px00075010252","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/NDL ASPIR/BX","code_information":[{"code":"Px00075010253","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DECOMPRESSION THROUGH STOMA","code_information":[{"code":"Px00075010254","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ABLATION","code_information":[{"code":"Px00075010255","type":"CDM"}],"standard_charges":[{"gross_charge":5738.0,"discounted_cash":4016.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/PLCMT STENT","code_information":[{"code":"Px00075010256","type":"CDM"}],"standard_charges":[{"gross_charge":5738.0,"discounted_cash":4016.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/RESECTION","code_information":[{"code":"Px00075010257","type":"CDM"}],"standard_charges":[{"gross_charge":5738.0,"discounted_cash":4016.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SGMDSC W/BAND LIGATION","code_information":[{"code":"Px00075010258","type":"CDM"}],"standard_charges":[{"gross_charge":5738.0,"discounted_cash":4016.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ABLATION","code_information":[{"code":"Px00075010259","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/STENT PLCMT","code_information":[{"code":"Px00075010260","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/RESECTION THROUGH STOMA","code_information":[{"code":"Px00075010261","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DECOMPRESSION","code_information":[{"code":"Px00075010262","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC COLONOSCOPY W/BAND LIGATION","code_information":[{"code":"Px00075010263","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC UNLISTED PROCEDURE COLON","code_information":[{"code":"Px00075010264","type":"CDM"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":3835.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 6","code_information":[{"code":"Px00075010272","type":"CDM"}],"standard_charges":[{"gross_charge":9160.0,"discounted_cash":6412.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPIC PANCREATOSCOPY","code_information":[{"code":"Px00075010306","type":"CDM"}],"standard_charges":[{"gross_charge":5384.0,"discounted_cash":3768.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY","code_information":[{"code":"Px00075010307","type":"CDM"}],"standard_charges":[{"gross_charge":8665.0,"discounted_cash":6065.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ULTRASOUND","code_information":[{"code":"Px00075010308","type":"CDM"}],"standard_charges":[{"gross_charge":4193.0,"discounted_cash":2935.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC EGD US FINE NEEDLE BX/ ASPIR","code_information":[{"code":"Px00075010311","type":"CDM"}],"standard_charges":[{"gross_charge":5384.0,"discounted_cash":3768.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESOPHAGOGASTRODUODENDOSCOPY US SCOPE W/ADJ STRXRS","code_information":[{"code":"Px00075010312","type":"CDM"}],"standard_charges":[{"gross_charge":5384.0,"discounted_cash":3768.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 1","code_information":[{"code":"Px00075010315","type":"CDM"}],"standard_charges":[{"gross_charge":4494.0,"discounted_cash":3145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 2","code_information":[{"code":"Px00075010316","type":"CDM"}],"standard_charges":[{"gross_charge":6614.0,"discounted_cash":4629.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 3","code_information":[{"code":"Px00075010317","type":"CDM"}],"standard_charges":[{"gross_charge":6892.0,"discounted_cash":4824.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 4","code_information":[{"code":"Px00075010318","type":"CDM"}],"standard_charges":[{"gross_charge":7971.0,"discounted_cash":5579.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 5","code_information":[{"code":"Px00075010319","type":"CDM"}],"standard_charges":[{"gross_charge":8569.0,"discounted_cash":5998.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":561.0,"discounted_cash":392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":841.0,"discounted_cash":588.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":755.0,"discounted_cash":528.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CLTX METACARPOPHALANGEAL DISLC W/MANIP W/O ANES CDM","code_information":[{"code":"Px00076100205","type":"CDM"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RECTAL SENSATION TONE&COMPLIANCE STUDY CDM","code_information":[{"code":"Px00076100249","type":"CDM"},{"code":"91124","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110006","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110021","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110039","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110040","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110041","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LACTATION CONSULT LEVEL 1","code_information":[{"code":"Px00076110134","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LACTATION CONSULT LEVEL 3","code_information":[{"code":"Px00076110136","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC RECTAL SENSATION TEST","code_information":[{"code":"Px00076110201","type":"CDM"},{"code":"91120","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":331.0,"discounted_cash":231.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HARVEST AUTO STEM CELLS","code_information":[{"code":"Px00076110203","type":"CDM"},{"code":"38206","type":"HCPCS"}],"standard_charges":[{"gross_charge":4751.0,"discounted_cash":3325.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJECTION AA&/STRD BRACH PLEX CONT NFS CATH IMG CDM","code_information":[{"code":"Px00076110208","type":"CDM"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1994.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PREVENTIVE COUNSELING INDIV 60 MIN","code_information":[{"code":"Px00076110297","type":"CDM"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PREVENTIVE COUNSELING INDIV 60 MIN","code_information":[{"code":"Px00076110298","type":"CDM"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REFIL/MAINT IMP PUM OR RES SPINAL/BRAIN BY RN CDM","code_information":[{"code":"Px00076110301","type":"CDM"},{"code":"95990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.0,"discounted_cash":1079.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":853.0,"discounted_cash":597.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REFILL/MAINT IMP PUM OR RES SPINAL/BRAIN BY MD CDM","code_information":[{"code":"Px00076110302","type":"CDM"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":863.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":853.0,"discounted_cash":597.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC REFILL MAINT PORTABLE PUMP CDM","code_information":[{"code":"Px00076110305","type":"CDM"},{"code":"96521","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC REFILL MAINT PUMP OR RESERVOIR (IV OR IA) CDM","code_information":[{"code":"Px00076110306","type":"CDM"},{"code":"96522","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IRRIGATION IMPLANTED VAD","code_information":[{"code":"Px00076110307","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":419.0,"discounted_cash":293.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PHOTODYNMC TX 30 MIN ADD-ON","code_information":[{"code":"Px00076110308","type":"CDM"},{"code":"96570","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PHOTODYNAMIC TX ADDL 15 MIN","code_information":[{"code":"Px00076110309","type":"CDM"},{"code":"96571","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5793.0,"discounted_cash":4055.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1386.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00076110466","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NEG PRESSURE WOUND THERAPY UTILIZING DME EQUIP>50 SQ CM CDM","code_information":[{"code":"Px00076110470","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LACTATION VISIT LEVEL 3","code_information":[{"code":"Px00076110537","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LACTATION CONSULT LVL 4","code_information":[{"code":"Px00076110542","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC LACTATION CONSULT LVL 5","code_information":[{"code":"Px00076110552","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR","code_information":[{"code":"Px00076147777","type":"CDM"},{"code":"38241","type":"HCPCS"}],"standard_charges":[{"gross_charge":5103.0,"discounted_cash":3572.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC HOSPITAL OBSERVATION PER HR CDM","code_information":[{"code":"Px00076210001","type":"CDM"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1480.0,"discounted_cash":1036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1340.0,"discounted_cash":938.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC COVID 19 IMMUNIZATION SINGLE DOSE ADMIN CDM","code_information":[{"code":"Px00077100046","type":"CDM"},{"code":"90480","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION (Base Price)"}]},{"description":"HC IMMUNIZATION ADMIN CDM","code_information":[{"code":"Px00077110001","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN EACH ADD CDM","code_information":[{"code":"Px00077110002","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ADMIN INFLUENZA VIRUS VAC CDM","code_information":[{"code":"Px00077110003","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ADMIN PNEUMOCOCCAL VACCINE CDM","code_information":[{"code":"Px00077110004","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION  (Unit Price)"}]},{"description":"HC THERAPEUTIC ULTRAFILTRATION CDM","code_information":[{"code":"Px00080000001","type":"CDM"},{"code":"0692T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1781.0,"discounted_cash":1246.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CCPD CYCLER","code_information":[{"code":"Px00080010003","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2380.0,"discounted_cash":1666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1307.0,"discounted_cash":914.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMODIALYSIS IP","code_information":[{"code":"Px00080110006","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":4664.0,"discounted_cash":3264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DIALYSIS THERAPY - SLOW DIALYTIC MODALITIES - EXTENDED/PROLONGED PERIOD","code_information":[{"code":"Px00080140000","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":12653.0,"discounted_cash":8857.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DIALYSIS CCPD IP","code_information":[{"code":"Px00080410001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2380.0,"discounted_cash":1666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1307.0,"discounted_cash":914.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ORGAN ACQ LIVE DONOR KIDNEY CDM","code_information":[{"code":"Px00081110001","type":"CDM"}],"standard_charges":[{"gross_charge":326000.0,"discounted_cash":228200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ORGAN ACQ CADAVERIC DONOR HEART CDM","code_information":[{"code":"Px00081200002","type":"CDM"}],"standard_charges":[{"gross_charge":187000.0,"discounted_cash":130900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ORGAN ACQ CADAVERIC DONOR KIDNEY CDM","code_information":[{"code":"Px00081210207","type":"CDM"}],"standard_charges":[{"gross_charge":98000.0,"discounted_cash":68600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ORGAN ACQ CADAVERIC DONOR PANCREAS CDM","code_information":[{"code":"Px00081210208","type":"CDM"}],"standard_charges":[{"gross_charge":104200.0,"discounted_cash":72940.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC STEM CELL HARVEST","code_information":[{"code":"Px00081910001","type":"CDM"},{"code":"38206","type":"HCPCS"}],"standard_charges":[{"gross_charge":5464.0,"discounted_cash":3824.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMODIAL OP ER/POSTOP NON ESRD","code_information":[{"code":"Px00082900001","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":4664.0,"discounted_cash":3264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2425.0,"discounted_cash":1697.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC HEMODIAL OP ER/POSTOP ESRD","code_information":[{"code":"Px00082910001","type":"CDM"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":4664.0,"discounted_cash":3264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2425.0,"discounted_cash":1697.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DIALYSIS CAPD OP","code_information":[{"code":"Px00084110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2380.0,"discounted_cash":1666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1307.0,"discounted_cash":914.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DIALYSIS CRRT OP","code_information":[{"code":"Px00088110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":12653.0,"discounted_cash":8857.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5000.0,"discounted_cash":3500.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PSYCH DIAG EVAL CDM","code_information":[{"code":"Px00090000072","type":"CDM"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":603.0,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PR 90791 PSYCH DIAG EVAL RHC","code_information":[{"code":"Px00090010042","type":"CDM"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":447.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":524.0,"discounted_cash":366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PR 90832 PSYTX W PT 30 MIN RHC","code_information":[{"code":"Px00090010043","type":"CDM"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PR 90834 PSYTX W PT 45 MIN RHC","code_information":[{"code":"Px00090010044","type":"CDM"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PR 90837 PSYTX W PT 60 MIN RHC","code_information":[{"code":"Px00090010045","type":"CDM"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PR 90839 PSYTX FOR CRISIS INITIAL 60 MIN RHC","code_information":[{"code":"Px00090010046","type":"CDM"},{"code":"90839","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":366.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PR 90840 PSYTX FOR CRISIS EA ADDTL 30 MIN RHC","code_information":[{"code":"Px00090010047","type":"CDM"},{"code":"90840","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 1 HOUR","code_information":[{"code":"Px00090110001","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":971.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1156.0,"discounted_cash":809.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 1.5 HOUR","code_information":[{"code":"Px00090110002","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2081.0,"discounted_cash":1456.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1735.0,"discounted_cash":1214.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 2 HOUR","code_information":[{"code":"Px00090110003","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1942.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2313.0,"discounted_cash":1619.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 2.5 HOUR","code_information":[{"code":"Px00090110004","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":3469.0,"discounted_cash":2428.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":2891.0,"discounted_cash":2023.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 3 HOUR","code_information":[{"code":"Px00090110005","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":4163.0,"discounted_cash":2914.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":3469.0,"discounted_cash":2428.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 3.5 HOUR","code_information":[{"code":"Px00090110006","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":3399.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4047.0,"discounted_cash":2832.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 4 HOUR","code_information":[{"code":"Px00090110007","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":5551.0,"discounted_cash":3885.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":4625.0,"discounted_cash":3237.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 4.5 HOUR","code_information":[{"code":"Px00090110008","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":6244.0,"discounted_cash":4370.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5204.0,"discounted_cash":3642.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELECTROCONVULSIVE THERAPY 5 HOUR","code_information":[{"code":"Px00090110009","type":"CDM"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":6938.0,"discounted_cash":4856.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":5782.0,"discounted_cash":4047.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN CDM","code_information":[{"code":"Px00091400024","type":"CDM"},{"code":"90839","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":420.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PSYCHOTHERAPY FOR CRISIS EA ADDTL 30 MIN CDM","code_information":[{"code":"Px00091400025","type":"CDM"},{"code":"90840","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PSYCHOTHERAPY W PT 45 MIN CDM","code_information":[{"code":"Px00091410047","type":"CDM"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PSYCHOTHERAPY W PT 60 MIN CDM","code_information":[{"code":"Px00091410111","type":"CDM"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PSYCHOTHERAPY W PT 30 MIN CDM","code_information":[{"code":"Px00091410112","type":"CDM"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC GROUP PSYCHOTHERAPY 60 MIN","code_information":[{"code":"Px00091510006","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC GROUP PSYCHOTHERAPY 75 MIN","code_information":[{"code":"Px00091510009","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC GROUP PSYCHOTHERAPY 15 MIN","code_information":[{"code":"Px00091510010","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC GROUP PSYCHOTHERAPY 30 MIN","code_information":[{"code":"Px00091510011","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC GROUP PSYCHOTHERAPY 45 MIN","code_information":[{"code":"Px00091510012","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC GROUP PSYCHOTHERAPY 105 MIN","code_information":[{"code":"Px00091510013","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":444.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PSYCHIATRIC SERVICE/THERAPY PHP 1 DAY","code_information":[{"code":"Px00091510025","type":"CDM"},{"code":"90899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.0,"discounted_cash":1334.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":342.0,"discounted_cash":239.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC GROUP PSYCHOTHERAPY 90 MIN","code_information":[{"code":"Px00091510031","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":475.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC GROUP PSYCHOTHERAPY 120 MIN","code_information":[{"code":"Px00091510033","type":"CDM"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 30 MIN","code_information":[{"code":"Px00091610001","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 60 MIN","code_information":[{"code":"Px00091610002","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 105 MIN","code_information":[{"code":"Px00091610004","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":450.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":530.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 120 MIN","code_information":[{"code":"Px00091610005","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":610.0,"discounted_cash":427.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 15 MIN","code_information":[{"code":"Px00091610006","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 45 MIN","code_information":[{"code":"Px00091610007","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 75 MIN","code_information":[{"code":"Px00091610008","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":420.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 90 MIN","code_information":[{"code":"Px00091610009","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC PSYCHOTHERAPY FAMILY W PT 50 MINS CDM","code_information":[{"code":"Px00091610011","type":"CDM"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC FAMILY PSYTX W/PATIENT 60 MIN","code_information":[{"code":"Px00091610012","type":"CDM"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC MULTIPLE FAMILY GROUP PSYTX 60 MIN","code_information":[{"code":"Px00091610023","type":"CDM"},{"code":"90849","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":454.0,"discounted_cash":317.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC MULTIPLE FAMILY GROUP PSYTX 90 MIN","code_information":[{"code":"Px00091610024","type":"CDM"},{"code":"90849","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":454.0,"discounted_cash":317.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH RISE"}]},{"description":"HC DEMONSTRATE USE HOME INR MON","code_information":[{"code":"Px00092010009","type":"CDM"},{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1065.0,"discounted_cash":745.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":380.0,"discounted_cash":266.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PROVIDE INR TEST MATER/EQUIP","code_information":[{"code":"Px00092010010","type":"CDM"},{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1013.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":581.0,"discounted_cash":406.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FETAL NON-STRESS TEST CDM","code_information":[{"code":"Px00092010032","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":528.0,"discounted_cash":369.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC FETAL CONTRACT STRESS TEST","code_information":[{"code":"Px00092010033","type":"CDM"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":528.0,"discounted_cash":369.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NERVE CONDUCTION STUDIES 1-2 STUDIES CDM","code_information":[{"code":"Px00092010039","type":"CDM"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 3-4 STUDIES CDM","code_information":[{"code":"Px00092010040","type":"CDM"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.0,"discounted_cash":940.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 5-6 STUDIES CDM","code_information":[{"code":"Px00092010041","type":"CDM"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.0,"discounted_cash":940.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 7-8 STUDIES CDM","code_information":[{"code":"Px00092010042","type":"CDM"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.0,"discounted_cash":940.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 9-10 STUDIES CDM","code_information":[{"code":"Px00092010043","type":"CDM"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":2577.0,"discounted_cash":1803.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 11-12 STUDIES CDM","code_information":[{"code":"Px00092010044","type":"CDM"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":2577.0,"discounted_cash":1803.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 13/> STUDIES CDM","code_information":[{"code":"Px00092010045","type":"CDM"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":2577.0,"discounted_cash":1803.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","code_information":[{"code":"Px00092010047","type":"CDM"},{"code":"95940","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC ELEC ALYS IMPLT SMPL CN NPGT PRGRMG","code_information":[{"code":"Px00092010075","type":"CDM"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELEC ALYS IMPLT CPLX CN NPGT PRGRMG","code_information":[{"code":"Px00092010076","type":"CDM"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":604.0,"discounted_cash":422.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN","code_information":[{"code":"Px00092010077","type":"CDM"},{"code":"95983","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":193.0,"discounted_cash":135.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN","code_information":[{"code":"Px00092010078","type":"CDM"},{"code":"95984","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":144.0,"discounted_cash":100.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL","code_information":[{"code":"Px00092010201","type":"CDM"},{"code":"92018","type":"HCPCS"}],"standard_charges":[{"gross_charge":7915.0,"discounted_cash":5540.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3137.0,"discounted_cash":2195.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":524.0,"discounted_cash":366.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","code_information":[{"code":"Px00092110003","type":"CDM"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":1368.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":524.0,"discounted_cash":366.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","code_information":[{"code":"Px00092110004","type":"CDM"},{"code":"93886","type":"HCPCS"}],"standard_charges":[{"gross_charge":2090.0,"discounted_cash":1463.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":761.0,"discounted_cash":532.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","code_information":[{"code":"Px00092110005","type":"CDM"},{"code":"93888","type":"HCPCS"}],"standard_charges":[{"gross_charge":2225.0,"discounted_cash":1557.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TCD EMBOL DETECT W/O INJ","code_information":[{"code":"Px00092110006","type":"CDM"},{"code":"93892","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":393.0,"discounted_cash":275.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC TCD W MICROBUBBLE INJ CDM","code_information":[{"code":"Px00092110007","type":"CDM"},{"code":"93893","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":393.0,"discounted_cash":275.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","code_information":[{"code":"Px00092110008","type":"CDM"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"discounted_cash":1285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2267.0,"discounted_cash":1586.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":688.0,"discounted_cash":481.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":3771.0,"discounted_cash":2639.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2522.0,"discounted_cash":1765.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":296.0,"discounted_cash":207.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2905.0,"discounted_cash":2033.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":2025.0,"discounted_cash":1417.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":293.0,"discounted_cash":205.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","code_information":[{"code":"Px00092110015","type":"CDM"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":3810.0,"discounted_cash":2667.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":420.0,"discounted_cash":294.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","code_information":[{"code":"Px00092110016","type":"CDM"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":2162.0,"discounted_cash":1513.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":296.0,"discounted_cash":207.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4960.0,"discounted_cash":3472.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":420.0,"discounted_cash":294.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3025.0,"discounted_cash":2117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","code_information":[{"code":"Px00092110019","type":"CDM"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":2616.0,"discounted_cash":1831.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1795.0,"discounted_cash":1256.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":296.0,"discounted_cash":207.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PENILE VASCULAR STUDY COMPLETE","code_information":[{"code":"Px00092110021","type":"CDM"},{"code":"93980","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1038.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD","code_information":[{"code":"Px00092110022","type":"CDM"},{"code":"93981","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1492.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":416.0,"discounted_cash":291.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DUPLEX SCAN HEMODIALYSIS ACCESS","code_information":[{"code":"Px00092110024","type":"CDM"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1805.0,"discounted_cash":1263.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":538.0,"discounted_cash":376.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD CDM","code_information":[{"code":"Px00092110025","type":"CDM"},{"code":"93985","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":656.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD CDM","code_information":[{"code":"Px00092110026","type":"CDM"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":317.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1718.0,"discounted_cash":1202.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":372.0,"discounted_cash":260.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":213.0,"discounted_cash":149.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":686.0,"discounted_cash":480.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":533.0,"discounted_cash":373.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210004","type":"CDM"},{"code":"95863","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":557.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":533.0,"discounted_cash":373.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210005","type":"CDM"},{"code":"95864","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":533.0,"discounted_cash":373.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI CDM","code_information":[{"code":"Px00092210007","type":"CDM"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":452.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":533.0,"discounted_cash":373.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI CDM","code_information":[{"code":"Px00092210009","type":"CDM"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":452.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":533.0,"discounted_cash":373.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SOMATOSENSORY TESTING UPPER LIMBS","code_information":[{"code":"Px00092210013","type":"CDM"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":3137.0,"discounted_cash":2195.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":1133.0,"discounted_cash":793.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC SOMATOSENSORY TESTING LOWER LIMBS","code_information":[{"code":"Px00092210018","type":"CDM"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":2772.0,"discounted_cash":1940.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":671.0,"discounted_cash":469.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC VISUAL EVOKED POTENTIAL TEST","code_information":[{"code":"Px00092210020","type":"CDM"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":1479.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":671.0,"discounted_cash":469.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NEUROMUSCULAR JUNCTION TEST","code_information":[{"code":"Px00092210023","type":"CDM"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":266.0,"discounted_cash":186.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BEHAV CHNG SMOKING 3-10 MIN","code_information":[{"code":"Px00094010003","type":"CDM"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":89.0,"discounted_cash":62.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC BEHAV CHNG SMOKING > 10 MIN","code_information":[{"code":"Px00094010004","type":"CDM"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":99.0,"discounted_cash":69.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSERT STRAIGHT CATH BLADDER","code_information":[{"code":"Px00094010050","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":411.0,"discounted_cash":287.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","code_information":[{"code":"Px00094010051","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":301.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":411.0,"discounted_cash":287.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC THER/PROPH/DIAG INJ INTRA-ARTERIAL CDM","code_information":[{"code":"Px00094010061","type":"CDM"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":298.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC THERAPUTIC PHLEBOTOMY","code_information":[{"code":"Px00094010204","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":338.0,"discounted_cash":236.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJ SQ OR IM CDM","code_information":[{"code":"Px00094010205","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJ IV PUSH INITIAL DRUG CDM","code_information":[{"code":"Px00094010207","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":250.0,"discounted_cash":175.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC INJ IV PUSH SEQUENTIAL NEW DRUG CDM","code_information":[{"code":"Px00094010208","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":104.0,"discounted_cash":72.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":131.0,"discounted_cash":91.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MED NUTRITION INDIV SUBSEQ BARIATIC EA 15 MIN","code_information":[{"code":"Px00094210009","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":115.0,"discounted_cash":80.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210013","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":115.0,"discounted_cash":80.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC CRISIS PHONE 99211 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210017","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRISIS PHONE 99212 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210018","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRISIS PHONE 99213 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210019","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRISIS PHONE 99214 LACTATION EDUCATION ESTAB PT VISIT  CDM","code_information":[{"code":"Px00094210020","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRISIS TELEH 97802 MEDICAL NUTRITION INDIV INIT THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00094210044","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC CRISIS TELEH 97803 MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210045","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":63.0,"discounted_cash":44.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC NUTRITION COUNSELING DIETITIAN VISIT","code_information":[{"code":"Px00094210320","type":"CDM"},{"code":"S9470","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":356.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 99401 PREVENTIVE COUNSELING INDIV 15 MIN","code_information":[{"code":"Px00096910176","type":"CDM"},{"code":"99401","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PR 99402 PREVENTIVE COUNSELING INDIV 30 MIN","code_information":[{"code":"Px00096910178","type":"CDM"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PR 99403 PREVENTIVE COUNSELING INDIV 45 MIN","code_information":[{"code":"Px00096910180","type":"CDM"},{"code":"99403","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PR 99404 PREVENTIVE COUNSELING INDIV 60 MIN","code_information":[{"code":"Px00096910182","type":"CDM"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":289.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"description":"HC PR 88108 CYTP CONCENTRATION SMEARS & INTERPRETATION #","code_information":[{"code":"Px00097100001","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 85576 PLATELET AGGREGATION IN VITRO EACH AGENT","code_information":[{"code":"Px00097100002","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 85576 PLATELET AGGREGATION IN VITRO EACH AGENT #","code_information":[{"code":"Px00097100003","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 85576 PLATELET AGGREGATION IN VITRO EACH AGENT #","code_information":[{"code":"Px00097100004","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 80503 PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN #","code_information":[{"code":"Px00097100006","type":"CDM"},{"code":"80503","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 80503 PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN CDM","code_information":[{"code":"Px00097100010","type":"CDM"},{"code":"80503","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 87207 SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00097100011","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 38220 DX BONE MARROW ASPIRATIONS","code_information":[{"code":"Px00097110001","type":"CDM"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 38221 DX BONE MARROW BIOPSIES","code_information":[{"code":"Px00097110002","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88108 BILL CYTO NON GYN CONC SMR-INT","code_information":[{"code":"Px00097110009","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88104 BILL CYTO NON-GYN","code_information":[{"code":"Px00097110014","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88311 BILL SURG DECAL","code_information":[{"code":"Px00097110019","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE #","code_information":[{"code":"Px00097110028","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88312 BILL SURG STAINS GROUP 1","code_information":[{"code":"Px00097110047","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88313 BILL SURG STAINS GROUP 2","code_information":[{"code":"Px00097110048","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88187 FLOW CYTO 2-8 MARKERS","code_information":[{"code":"Px00097110053","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88188 FLOW CYTO 9-15 MARKERS","code_information":[{"code":"Px00097110054","type":"CDM"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88189 FLOW CYTO GT 16 MARKERS","code_information":[{"code":"Px00097110055","type":"CDM"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88108 FLUID WASH BRUSH CONC","code_information":[{"code":"Px00097110058","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88365 IN SITU HYBRIDIZATION","code_information":[{"code":"Px00097110060","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88305 MUSCLE BIOPSY (OF PANL)","code_information":[{"code":"Px00097110073","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88319 Z8831926 REF LAB","code_information":[{"code":"Px00097110088","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 85097 BONE MARROW INTERPRETATION","code_information":[{"code":"Px00097110117","type":"CDM"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION","code_information":[{"code":"Px00097110120","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88341 IMMUNOHISTO ANTIBODY SLIDE EA ADDL","code_information":[{"code":"Px00097110163","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88364 INSITU HYBRIDIZATION (FISH) EACH ADDL","code_information":[{"code":"Px00097110165","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERP","code_information":[{"code":"Px00097110198","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 85576 BLOOD PLATELET AGGREGATION","code_information":[{"code":"Px00097110211","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 87207 SMEAR SPECIAL STAIN","code_information":[{"code":"Px00097110223","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 88305 TISSUE EXAM BY PATHOLOGIST","code_information":[{"code":"Px00097110230","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR DX BONE MARROW BX & ASPIR","code_information":[{"code":"Px00097510300","type":"CDM"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR ED 99309 SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES CDM","code_information":[{"code":"Px00098110047","type":"CDM"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":551.0,"discounted_cash":385.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"},{"gross_charge":551.0,"discounted_cash":385.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH OUTPATIENT"}]},{"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":272.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR S9436 LA MAZE CHILDBIRTH CLASS PER SESSION","code_information":[{"code":"Px00098210015","type":"CDM"},{"code":"S9436","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR FLIGHT PHYSICAL","code_information":[{"code":"Px00098210172","type":"CDM"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR 28666 FIXATION OF INTERPHALANGEL JOINT DISLOCATION W/MAN","code_information":[{"code":"Px00098210173","type":"CDM"},{"code":"28666","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PR CONSISTENT CARE 1ST YEAR RENEWAL","code_information":[{"code":"Px00098210175","type":"CDM"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"HC PACEMAKER CARDIAC .75CM 4.45CM X U226","code_information":[{"code":"Px000S315743L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":10631.0,"discounted_cash":7441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION  (Unit Price)"}]},{"description":"SOTALOL 5 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx0000-0032-2","type":"CDM"},{"code":"0000-0032-26","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRISMASATE BK 0/3.5 DIALYSIS SOLUTION","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000000000","type":"CDM"}],"standard_charges":[{"gross_charge":192.94,"discounted_cash":135.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRISMASATE B22GK 4/0 DIALYSIS SOLUTION","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000000000","type":"CDM"}],"standard_charges":[{"gross_charge":192.94,"discounted_cash":135.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRISMASATE BGK 4/2.5 DIALYSIS SOLUTION","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000000000","type":"CDM"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRISMASATE BGK 2/0 DIALYSIS SOLUTION","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000000000","type":"CDM"}],"standard_charges":[{"gross_charge":187.2,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIODARONE 5 MG/ML SUSPENSION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000008","type":"CDM"},{"code":"00000000008","type":"NDC"}],"standard_charges":[{"gross_charge":25.08,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE 10 MCG/ML SUSPENSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000018","type":"CDM"},{"code":"00000000018","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE 25 MCG/ML SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000023","type":"CDM"},{"code":"00000000023","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM PHOSPHATE LIQUID 3 MMOL/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000026","type":"CDM"},{"code":"00000000026","type":"NDC"}],"standard_charges":[{"gross_charge":14.51,"discounted_cash":10.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM ACETATE LIQUID 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000028","type":"CDM"},{"code":"00000000028","type":"NDC"}],"standard_charges":[{"gross_charge":26.29,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SPIRONOLACTONE SUSP 25 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000000035","type":"CDM"},{"code":"00000000035","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"URSODIOL 20 MG/ML SUSPENSION","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000000036","type":"CDM"},{"code":"00000000036","type":"NDC"}],"standard_charges":[{"gross_charge":15.87,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE 1 MG/ML SUSPENSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000041","type":"CDM"},{"code":"00000000041","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000048","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00000000048","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE 5 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000000050","type":"CDM"},{"code":"00000000050","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOLN PREF SYR 10 MCG/ML,EPINEPHRINE HCL-NACL IV SOLN PREF SYR 50 MCG/5ML-0.9%,EPINEPHRINE HCL-NACL IV SOLN PREF SYR 100 MCG/10ML-0.9%,EPINEPHRINE HCL-NACL IV SOL PREF SYR 200 MCG/20ML-0.9%,EPINEPHRINE HCL-NACL IV SOL PREF SYR 500 MCG/50ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 0.1 MG/10ML (10 MCG/ML),EPINEPHRINE-DEXTROSE IV SOLN PREF SYR 100 MCG/10ML-5%,EPINEPHRINE BITART-NACL IV SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000056","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000000056","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACIDS 3%-HEPARIN 0.5 UNIT/ML INFUSION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000090","type":"CDM"},{"code":"00000000090","type":"NDC"}],"standard_charges":[{"gross_charge":385.75,"discounted_cash":270.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE 1%-EPINEPHRINE 1:100000 BUFFERED INJECTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000144","type":"CDM"},{"code":"00000000144","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000000147","type":"CDM"},{"code":"00000000147","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROPRUSSIDE 50 MG IN 250 ML NS INFUSION ONE STEP","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000000150","type":"CDM"},{"code":"00000000150","type":"NDC"}],"standard_charges":[{"gross_charge":181.3,"discounted_cash":126.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1447.24,"discounted_cash":1013.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACIDS 3%-D10W-CALCIUM GLUCONATE 2 MG/ML-HEPARIN 0.5 UNIT/ML INFUSION","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000000160","type":"CDM"},{"code":"00000000160","type":"NDC"}],"standard_charges":[{"gross_charge":462.9,"discounted_cash":324.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARVEDILOL 1.67 MG/ML SUSPENSION","drug_information":{"unit":0.9375,"type":"ML"},"code_information":[{"code":"Rx00000000172","type":"CDM"},{"code":"00000000172","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILDENAFIL 2.5 MG/ML SUSPENSION","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000000181","type":"CDM"},{"code":"00000000181","type":"NDC"}],"standard_charges":[{"gross_charge":12.09,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALLOPURINOL 20 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000000220","type":"CDM"},{"code":"00000000220","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MISOPROSTOL 25 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000240","type":"CDM"},{"code":"00000000240","type":"NDC"}],"standard_charges":[{"gross_charge":48.12,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 25 MCG"}]},{"description":"CAPTOPRIL 1 MG/ML SUSPENSION","drug_information":{"unit":3.125,"type":"ML"},"code_information":[{"code":"Rx00000000258","type":"CDM"},{"code":"00000000258","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFOXITIN 100 MG/ML IV SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000310","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00000000310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME 100 MG/ML IV SYRINGE","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000000314","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00000000314","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN 5 MG/ML IV SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000323","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000000323","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE 0.5%-EPINEPHRINE 1:200000 50 ML WITH NS 50 ML INJECTION ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000327","type":"CDM"},{"code":"00000000327","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE 0.25%-EPI 1:200000 30 ML WITH LIDOCAINE 1%-EPI 1:100000 30 ML INJECTION ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000000330","type":"CDM"},{"code":"00000000330","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STERILE DILUENT FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000333","type":"CDM"},{"code":"00000000333","type":"NDC"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":60.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN B 1 ML IN 1000 ML NS IRRIGATION ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000000342","type":"CDM"},{"code":"00000000342","type":"NDC"}],"standard_charges":[{"gross_charge":169.54,"discounted_cash":118.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN 1 G IN 10 ML STERILE WATER INJECTION ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000355","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000355","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":74.89,"discounted_cash":52.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 100 MG/ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 2 GM/20ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 1 GM/10ML,CEFAZOLIN SODIUM INJ SOLN PREF SYRINGE 3 GM/30ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000378","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000378","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZINC (ELEMENTAL) 1 MG/ML SUSPENSION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000381","type":"CDM"},{"code":"00000000381","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIOGUANINE 20 MG/ML SUSPENSION","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000387","type":"CDM"},{"code":"00000000387","type":"NDC"}],"standard_charges":[{"gross_charge":231.71,"discounted_cash":162.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN 5 MG/ML SUSPENSION","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000389","type":"CDM"},{"code":"00000000389","type":"NDC"}],"standard_charges":[{"gross_charge":19.28,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000405","type":"CDM"},{"code":"00000000405","type":"NDC"}],"standard_charges":[{"gross_charge":13.4,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 500 UNIT/ML,INSULIN REGULAR (HUMAN) SOLN PEN-INJECTOR 500 UNIT/ML","drug_information":{"unit":5.0,"type":"UN"},"code_information":[{"code":"Rx00000000410","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000000410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL ELIXIR 20 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00000000414","type":"CDM"},{"code":"00000000414","type":"NDC"}],"standard_charges":[{"gross_charge":13.48,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMOZOLOMIDE 10 MG/ML SUSPENSION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000416","type":"CDM"},{"code":"J8700","type":"HCPCS"},{"code":"00000000416","type":"NDC"}],"standard_charges":[{"gross_charge":3526.65,"discounted_cash":2468.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE 1:1000 0.3 ML IN 1000 ML NS IRRIGATION ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000000433","type":"CDM"},{"code":"00000000433","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE 8 MG IN 500 ML NS INFUSION ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000000439","type":"CDM"},{"code":"00000000439","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL 10 MCG/ML PCA SYRINGE,FENTANYL CITRATE-NACL SOLN PREF SYR 550 MCG/55ML-0.9%,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 500 MCG/50ML,FENTANYL CITRATE-NACL SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000452","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000000452","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN 100 MCG/ML SYRINGE ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000536","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00000000536","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAZOLAMIDE 25 MG/ML ORAL SUSPENSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000537","type":"CDM"},{"code":"00000000537","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZATHIOPRINE 50 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000539","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00000000539","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOLIC ACID 1 MG/ML ORAL LIQUID","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00000000541","type":"CDM"},{"code":"00000000541","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDRALAZINE 4 MG/ML ORAL SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000000542","type":"CDM"},{"code":"00000000542","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx00000000545","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00000000545","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000553","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00000000553","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000556","type":"CDM"},{"code":"00000000556","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL 10 MG + NITROGLYCERIN 1 MG + NORMAL SALINE 16 ML - ONE STEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000572","type":"CDM"},{"code":"00000000572","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO DILUTE 10 UNIT/ML SUBQ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000634","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000000634","type":"NDC"}],"standard_charges":[{"gross_charge":356.58,"discounted_cash":249.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FORMALDEHYDE 1% IN NORMAL SALINE IRRIGATION 1000 ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000000650","type":"CDM"},{"code":"00000000650","type":"NDC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHYTONADIONE 10 MG/ML PO SOLN (FROM INJ)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000000681","type":"CDM"},{"code":"00000000681","type":"NDC"}],"standard_charges":[{"gross_charge":20.23,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-PORFIMER SODIUM 75 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000754","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000754","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-BRENTUXIMAB VEDOTIN 5 MG/ML IV SOLR","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000763","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000763","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-GEMCITABINE HCL 200 IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000780","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000780","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE INJ 2 MG/ML IN D5W","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000796","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00000000796","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE INJ 2 MG/ML IN D5W","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000797","type":"CDM"},{"code":"00000000797","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOPAMINE INJ 1.6 MG/ML IN D5W","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000798","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00000000798","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000803","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00000000803","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"},{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000804","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00000000804","type":"NDC"}],"standard_charges":[{"gross_charge":368.88,"discounted_cash":258.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VECURONIUM BROMIDE 1 MG/ML IV SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000806","type":"CDM"},{"code":"00000000806","type":"NDC"}],"standard_charges":[{"gross_charge":523.26,"discounted_cash":366.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VECURONIUM BROMIDE 1 MG/ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000807","type":"CDM"},{"code":"00000000807","type":"NDC"}],"standard_charges":[{"gross_charge":872.11,"discounted_cash":610.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-BLINATUMOMAB IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000811","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000811","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-BLINATUMOMAB STABILIZER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000812","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000812","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NADOLOL 10 MG/ML PO SUSPENSION","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000000822","type":"CDM"},{"code":"00000000822","type":"NDC"}],"standard_charges":[{"gross_charge":12.45,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000000901","type":"NDC"}],"standard_charges":[{"gross_charge":46.88,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-VX 661-IVACAFTOR 100-150 MG TAB (VX14-661-110 NCT02565914)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000921","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000921","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN REGULAR INFUSION 0.2 UNIT/ML IN NS (NICU SYRINGES) SIMPLE","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000000964","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000000964","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-LENALIDOMIDE 2.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000975","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000975","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-LENALIDOMIDE 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000976","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000976","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-LENALIDOMIDE 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000980","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000980","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUMETANIDE 0.25 MG/ML PO SOLN (FROM INJ)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000989","type":"CDM"},{"code":"00000000989","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE (CYTOXAN) 10 MG/ML ORAL SUSPENSION (PEDS)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000000991","type":"CDM"},{"code":"J8530","type":"HCPCS"},{"code":"00000000991","type":"NDC"}],"standard_charges":[{"gross_charge":1887.22,"discounted_cash":1321.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN REGULAR INFUSION 0.2 UNIT/ML IN NS (NICU SYRINGES) SIMPLE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001038","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000001038","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001043","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000001043","type":"NDC"}],"standard_charges":[{"gross_charge":751.92,"discounted_cash":526.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 1 MG/ML,MORPHINE SULFATE IV SOLN PF 1 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000001052","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000001052","type":"NDC"}],"standard_charges":[{"gross_charge":144.42,"discounted_cash":101.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-TEMSIROLIMUS 10 MG/ML (FINAL CONCENTRATION) IV SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001063","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000001063","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE 0.05 MG/24HR TD PTWK (OCCLUDED 0.1 MG PATCH)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001106","type":"CDM"},{"code":"00000001106","type":"NDC"}],"standard_charges":[{"gross_charge":24.87,"discounted_cash":17.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL 6 MCG/HR TD PT72 (OCCLUDED 12 MCG PATCH)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001107","type":"CDM"},{"code":"00000001107","type":"NDC"}],"standard_charges":[{"gross_charge":38.43,"discounted_cash":26.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 0.5 MG/3DAYS (OCCLUDED 1 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001108","type":"CDM"},{"code":"00000001108","type":"NDC"}],"standard_charges":[{"gross_charge":47.36,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEXILETINE 10 MG/ML PO SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000001154","type":"CDM"},{"code":"00000001154","type":"NDC"}],"standard_charges":[{"gross_charge":29.6,"discounted_cash":20.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000001175","type":"CDM"},{"code":"00000001175","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-DABIGATRAN EXTEXILATE MESYLATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001183","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000001183","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-DABIGATRAN EXTEXILATE MESYLATE 110 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001185","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000001185","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-DABIGATRAN EXTEXILATE MESYLATE 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001186","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000001186","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-OFATUMUMAB/PLACEBO 0.4 ML SYRINGE (NOVARTIS COMB157G2302 NCT02792231)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001260","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000001260","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL-SODIUM CHLORIDE 0.9% EPIDURAL INJ 0.125%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001278","type":"CDM"},{"code":"00000001278","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL-BUPIVACAINE 2 MCG-0.1 %,FENTANYL 0.2 MG/100ML-BUPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.5 MG/250ML-BUPIV 0.1%-NACL 0.9% PF EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001279","type":"CDM"},{"code":"00000001279","type":"NDC"}],"standard_charges":[{"gross_charge":231.45,"discounted_cash":162.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-BRENTUXIMAB VEDOTIN 5 MG/ML IV SOLN (ANHL12P1 NCT01979536)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001283","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000001283","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LANSOPRAZOLE SUSP 3 MG/ML (COMPOUND KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001290","type":"CDM"},{"code":"00000001290","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":9.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-CRIZOTINIB 200 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001301","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00000001301","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-CRIZOTINIB 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001302","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00000001302","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ORGAN TRANSPLANT SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000001310","type":"CDM"},{"code":"00000001310","type":"NDC"}],"standard_charges":[{"gross_charge":79.29,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTOBARBITAL SODIUM 4 MG/ML IN SALINE IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000001352","type":"CDM"},{"code":"J2515","type":"HCPCS"},{"code":"00000001352","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-AZACITIDINE 100 MG INJECTION SUSR (AALL15P1 NCT02828358)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001376","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000001376","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-CABOZANTINIB S-MALATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001389","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00000001389","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 30 TABLET"}]},{"description":"STUDY-CABOZANTINIB S-MALATE 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001390","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00000001390","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 30 TABLET"}]},{"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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000001481","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00000001481","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6766.96,"discounted_cash":4736.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":39937.94,"discounted_cash":27956.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MISOPROSTOL 50 MCG PO TABS (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001526","type":"CDM"},{"code":"00000001526","type":"NDC"}],"standard_charges":[{"gross_charge":11.99,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 50 MCG"}]},{"description":"ALTEPLASE CATH DECLOT IN SW INJ 0.5MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000001532","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001532","type":"NDC"}],"standard_charges":[{"gross_charge":660.96,"discounted_cash":462.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000001538","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000001538","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALTEPLASE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001553","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001553","type":"NDC"}],"standard_charges":[{"gross_charge":1028.32,"discounted_cash":719.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALTEPLASE 20MG/20 ML INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000001554","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001554","type":"NDC"}],"standard_charges":[{"gross_charge":3595.29,"discounted_cash":2516.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALTEPLASE CATH DECLOT IN SW INJ 0.5MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000001555","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001555","type":"NDC"}],"standard_charges":[{"gross_charge":1139.39,"discounted_cash":797.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALTEPLASE FOR INJ 50 MG","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00000001556","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001556","type":"NDC"}],"standard_charges":[{"gross_charge":769.53,"discounted_cash":538.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL-BUPIVACAINE 2 MCG-0.1 %,FENTANYL 0.2 MG/100ML-BUPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.5 MG/250ML-BUPIV 0.1%-NACL 0.9% PF EPIDURAL INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000001565","type":"CDM"},{"code":"00000001565","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001568","type":"CDM"},{"code":"00000001568","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN 240 MG IN 3000 ML NS IRRIGATION BAG ONE STEP","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00000001626","type":"CDM"},{"code":"00000001626","type":"NDC"}],"standard_charges":[{"gross_charge":123.89,"discounted_cash":86.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROPRUSSIDE 100 MCG/ML SYRINGE ONE STEP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001632","type":"CDM"},{"code":"00000001632","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYUREA 100 MG/ML SUSPENSION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000001637","type":"CDM"},{"code":"00000001637","type":"NDC"}],"standard_charges":[{"gross_charge":45.46,"discounted_cash":31.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MINERAL OIL-GLYCERIN RE ENEM","drug_information":{"unit":240.0,"type":"ML"},"code_information":[{"code":"Rx00000001706","type":"CDM"},{"code":"00000001706","type":"NDC"}],"standard_charges":[{"gross_charge":56.01,"discounted_cash":39.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE 2% 20 ML WITH EPINEPHRINE 1:1000 1ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000001720","type":"CDM"},{"code":"00000001720","type":"NDC"}],"standard_charges":[{"gross_charge":201.93,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00000001785","type":"CDM"},{"code":"00000001785","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"1:1 BUPIVACAINE 0.25% & BUPIVACAINE 0.25%-EPI 1:200,000 ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000001820","type":"CDM"},{"code":"00000001820","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZATHIOPRINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001823","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00000001823","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE IV SOLN 250 MG/50ML (BASE EQ)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000001825","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"00000001825","type":"NDC"}],"standard_charges":[{"gross_charge":934.16,"discounted_cash":653.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIODARONE (CORDARONE) INFUSION 180 MG IN 100 ML NS IVPB ONE P","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000001835","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000001835","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICARDIPINE 100 MCG/ML IN NS INFUSION ONE STEP","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000001880","type":"CDM"},{"code":"00000001880","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN TAB 2.5 MG (CUSTOM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000002073","type":"CDM"},{"code":"00000002073","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 1 TABLET"}]},{"description":"PHENYLEPHRINE 100 MCG/ML IN 20 ML NS - ONE STEP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000002137","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00000002137","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":385.75,"discounted_cash":270.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRANEXAMIC ACID 1 G IN 50 ML NS INFUSION ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002166","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000002166","type":"NDC"}],"standard_charges":[{"gross_charge":925.8,"discounted_cash":648.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL 10 MCG/ML INFUSION (NICU 20 ML SYRINGE)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000002187","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000002187","type":"NDC"}],"standard_charges":[{"gross_charge":235.15,"discounted_cash":164.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL 10 MCG/ML INFUSION (NICU 5 ML SYRINGE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002188","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000002188","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000002195","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000002195","type":"NDC"}],"standard_charges":[{"gross_charge":303.97,"discounted_cash":212.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM INJ 1MG/ML - 5ML SYRINGE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002198","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000002198","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM HCL IV SOLN 150 MG/30ML (BASE EQUIVALENT),MIDAZOLAM HCL IV SOLN PREFILLED SYRINGE 150 MG/30ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002199","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000002199","type":"NDC"}],"standard_charges":[{"gross_charge":151.98,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx00000002202","type":"CDM"},{"code":"00000002202","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE 200 MCG/ML PCA","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002211","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000002211","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 1.75 GM/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000002215","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000002215","type":"NDC"}],"standard_charges":[{"gross_charge":223.73,"discounted_cash":156.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000002218","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000002218","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 2 GM/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000002220","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000002220","type":"NDC"}],"standard_charges":[{"gross_charge":1128.6,"discounted_cash":790.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE 100 MCG/0.1 ML (AKA INTRAVITREAL)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00000002225","type":"CDM"},{"code":"00000002225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002229","type":"CDM"},{"code":"00000002229","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE 0.5% + EPINEPHRINE 1:400,000 IN 30 ML SYRINGE - ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002246","type":"CDM"},{"code":"00000002246","type":"NDC"}],"standard_charges":[{"gross_charge":282.86,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE 0.5% + EPINEPHRINE 1:400,000 + BUPRENORPHINE 300 MCG + CLONIDINE 100 MCG IN 30 ML SYRINGE - ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002247","type":"CDM"},{"code":"00000002247","type":"NDC"}],"standard_charges":[{"gross_charge":127.76,"discounted_cash":89.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE 0.5% + EPINEPHRINE 1:400,000 + BUPRENORPHINE 300 MCG + CLONIDINE 100 MCG + DEXAMETHASONE 4 MG IN 30 ML SYRINGE - ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002248","type":"CDM"},{"code":"00000002248","type":"NDC"}],"standard_charges":[{"gross_charge":838.49,"discounted_cash":586.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BABY BAG WITH CALCIUM (WSH)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000002250","type":"CDM"},{"code":"00000002250","type":"NDC"}],"standard_charges":[{"gross_charge":513.04,"discounted_cash":359.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BABY BAG WITHOUT CALCIUM","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000002251","type":"CDM"},{"code":"00000002251","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN LIQUID 50 MG/ML (FROM INJECTION)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000002260","type":"CDM"},{"code":"00000002260","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-BORTEZOMIB 3.5 MG INJECTION SOLR (AALL1231 NCT02112916)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000002261","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000002261","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002327","type":"CDM"},{"code":"00000002327","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) 100 UNT/ML IN SODIUM CHLORIDE 0.45% SYRINGE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002362","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000002362","type":"NDC"}],"standard_charges":[{"gross_charge":147.4,"discounted_cash":103.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL-SODIUM CHLORIDE EPIDURAL INJ 0.1-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000002413","type":"CDM"},{"code":"00000002413","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 5 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002426","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000002426","type":"NDC"}],"standard_charges":[{"gross_charge":178.67,"discounted_cash":125.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002479","type":"CDM"},{"code":"00000002479","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002504","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000002504","type":"NDC"}],"standard_charges":[{"gross_charge":252.28,"discounted_cash":176.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":331.74,"discounted_cash":232.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002573","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00000002573","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"},{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000002588","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00000002588","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000002594","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00000002594","type":"NDC"}],"standard_charges":[{"gross_charge":151.01,"discounted_cash":105.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000002614","type":"CDM"},{"code":"00000002614","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCYTOSINE 50 MG/ML SUSPENSION","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000002625","type":"CDM"},{"code":"00000002625","type":"NDC"}],"standard_charges":[{"gross_charge":602.31,"discounted_cash":421.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 2.5 GM/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000002661","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000002661","type":"NDC"}],"standard_charges":[{"gross_charge":231.45,"discounted_cash":162.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL IN NACL 2.25-0.9 GM/500ML-% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000002663","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000002663","type":"NDC"}],"standard_charges":[{"gross_charge":231.45,"discounted_cash":162.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BEVACIZUMAB 12.5 MG/ML INTRAOCULAR SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx00000002683","type":"CDM"},{"code":"C9257","type":"HCPCS"},{"code":"00000002683","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":217.99,"discounted_cash":152.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS 1 MG/ML SUSPENSION","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000002720","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00000002720","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/250ML,FENTANYL CITRATE-NACL PF 0.9% IV SOLN 1 MG/100 ML (10 MCG/ML),FENTANYL CITRATE-NACL 0.9% INJ SOLN 1 MG/100ML,FENTANYL CITRATE-NACL 0.9% INJ SOLN 2.5 MG/250ML,FENTANYL CITRATE IV SOLN 1000 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000002775","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000002775","type":"NDC"}],"standard_charges":[{"gross_charge":1157.25,"discounted_cash":810.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMILORIDE HCL 1 MG/ML PO SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002794","type":"CDM"},{"code":"00000002794","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 5% IV SOLN 900 MG/500ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002877","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000002877","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002880","type":"CDM"},{"code":"00000002880","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002881","type":"CDM"},{"code":"00000002881","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-CSL112/PLACEBO INFUSION (DEHP-FREE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000002955","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000002955","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"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":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.27,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003150","type":"CDM"},{"code":"00000003150","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHOTERICIN B 0.005 MG/0.1 ML IN 0.9 % NACL (PF)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003185","type":"CDM"},{"code":"J0285","type":"HCPCS"},{"code":"00000003185","type":"NDC"}],"standard_charges":[{"gross_charge":223.23,"discounted_cash":156.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME 2.25 MG/0.1 ML IN 0.9 % NACL (PF)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003186","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000003186","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN 1 MG/0.1 ML IN 0.9 % NACL (PF)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003189","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000003189","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATENOLOL 2 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003192","type":"CDM"},{"code":"00000003192","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BETHANECHOL 1 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003193","type":"CDM"},{"code":"00000003193","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOPIDOGREL 5 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003198","type":"CDM"},{"code":"00000003198","type":"NDC"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":14.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIAZOXIDE 50 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003202","type":"CDM"},{"code":"00000003202","type":"NDC"}],"standard_charges":[{"gross_charge":23.88,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOLIC ACID 1 MG/ML ORAL LIQUID","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003207","type":"CDM"},{"code":"00000003207","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISRADIPINE 1 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003210","type":"CDM"},{"code":"00000003210","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL 40 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003212","type":"CDM"},{"code":"00000003212","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOSARTAN 2.5 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003215","type":"CDM"},{"code":"00000003215","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOLAZONE 1 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003216","type":"CDM"},{"code":"00000003216","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 4 MG/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000003246","type":"CDM"},{"code":"00000003246","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BETAMETHASONE 6 MG WITH 1 ML NS INJECTION ONE STEP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000003263","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00000003263","type":"NDC"}],"standard_charges":[{"gross_charge":102.22,"discounted_cash":71.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL SOLN 10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003296","type":"CDM"},{"code":"00000003296","type":"NDC"}],"standard_charges":[{"gross_charge":12.49,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL 0.2% ON-Q SINGLE LUMEN PUMP","drug_information":{"unit":750.0,"type":"ML"},"code_information":[{"code":"Rx00000003319","type":"CDM"},{"code":"00000003319","type":"NDC"}],"standard_charges":[{"gross_charge":985.32,"discounted_cash":689.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE 0.5% SNGL LUMN ON-Q PUMP 270 ML","drug_information":{"unit":270.0,"type":"ML"},"code_information":[{"code":"Rx00000003321","type":"CDM"},{"code":"00000003321","type":"NDC"}],"standard_charges":[{"gross_charge":257.58,"discounted_cash":180.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL INJ 2 MG/ML,HYDROMORPHONE HCL INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 2 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.2 MG/0.2ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/0.5ML-0.9%,HYDROMORPHONE HCL INJ 0.5 MG/ML,HYDROMORPHONE HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003352","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000003352","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POVIDONE IODINE SOLUTION 20 ML IN NS 80 ML - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003381","type":"CDM"},{"code":"00000003381","type":"NDC"}],"standard_charges":[{"gross_charge":135.45,"discounted_cash":94.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRYPAN BLUE 0.06 % OPHTHALMIC SOLUTION 0.5 ML - ONE STEP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000003386","type":"CDM"},{"code":"00000003386","type":"NDC"}],"standard_charges":[{"gross_charge":332.73,"discounted_cash":232.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VASOPRESSIN 20 UNITS IN NORMAL SALINE 100 ML - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003388","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000003388","type":"NDC"}],"standard_charges":[{"gross_charge":1723.07,"discounted_cash":1206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE LIQ 2.5-0.025 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003402","type":"CDM"},{"code":"00000003402","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003413","type":"CDM"},{"code":"00000003413","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003432","type":"CDM"},{"code":"00000003432","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003437","type":"CDM"},{"code":"00000003437","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003438","type":"CDM"},{"code":"00000003438","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003511","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00000003511","type":"NDC"}],"standard_charges":[{"gross_charge":678.14,"discounted_cash":474.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZATHIOPRINE 50 MG/ML ORAL SUSPENSION","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000003558","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00000003558","type":"NDC"}],"standard_charges":[{"gross_charge":44.84,"discounted_cash":31.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003570","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"00000003570","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SORBITOL ORAL SOLUTION 70%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000003637","type":"CDM"},{"code":"00000003637","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN 100 MCG/ML SYRINGE ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003644","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00000003644","type":"NDC"}],"standard_charges":[{"gross_charge":205.11,"discounted_cash":143.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BETADINE PAINT 9 ML MIXED WITH 250 ML NS - ONE STEP","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000003705","type":"CDM"},{"code":"00000003705","type":"NDC"}],"standard_charges":[{"gross_charge":147.77,"discounted_cash":103.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"1:1 BUPIVACAINE 0.5%-EPI 1:200000 WITH LIDOCAINE 1% ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003707","type":"CDM"},{"code":"00000003707","type":"NDC"}],"standard_charges":[{"gross_charge":168.38,"discounted_cash":117.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000003785","type":"CDM"},{"code":"00000003785","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE 1% 20ML + EPINEPHRINE (1:1000) 1ML IN NS 1000 ML ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000003809","type":"CDM"},{"code":"00000003809","type":"NDC"}],"standard_charges":[{"gross_charge":1797.27,"discounted_cash":1258.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MERCAPTOPURINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003842","type":"CDM"},{"code":"00000003842","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE 0.5%-EPI 1:200000 30 ML WITH LIDOCAINE 1% 30 ML ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000003866","type":"CDM"},{"code":"00000003866","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003902","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00000003902","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000003904","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000003904","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003955","type":"CDM"},{"code":"00000003955","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003956","type":"CDM"},{"code":"00000003956","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx00000003957","type":"CDM"},{"code":"00000003957","type":"NDC"}],"standard_charges":[{"gross_charge":17.51,"discounted_cash":12.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx00000003958","type":"CDM"},{"code":"00000003958","type":"NDC"}],"standard_charges":[{"gross_charge":15.16,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 1.75 GM/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003964","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000003964","type":"NDC"}],"standard_charges":[{"gross_charge":293.17,"discounted_cash":205.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL INJ (PF) 50 MCG/ML SYRINGE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003965","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000003965","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000003989","type":"CDM"},{"code":"00000003989","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004000","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004000","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1965.36,"discounted_cash":1375.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":477.0,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":159.79,"discounted_cash":111.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":235.32,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":473.82,"discounted_cash":331.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":235.32,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000004031","type":"CDM"},{"code":"00000004031","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BETADINE SOLUTION 17 ML IN NS 500 ML - ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004048","type":"CDM"},{"code":"00000004048","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":154.3,"discounted_cash":108.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NON DATABASE MEDICATION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004160","type":"CDM"},{"code":"00000004160","type":"NDC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004164","type":"CDM"},{"code":"00000004164","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004165","type":"CDM"},{"code":"00000004165","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004168","type":"CDM"},{"code":"00000004168","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"discounted_cash":9.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE 50 MG/ML (4.93 MG/ML ELEMENTAL) PO LIQUID","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004188","type":"CDM"},{"code":"00000004188","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACOSAMIDE ORAL SOLUTION 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004234","type":"CDM"},{"code":"00000004234","type":"NDC"}],"standard_charges":[{"gross_charge":19.74,"discounted_cash":13.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MERCAPTOPURINE TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004241","type":"CDM"},{"code":"00000004241","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN REGULAR 0.2 UNIT/ML IN NS INJ INTERMITTENT","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000004363","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000004363","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004518","type":"CDM"},{"code":"00000004518","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN 3 G IN 3000 ML NS IRRIGATION ONE STEP","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00000004581","type":"CDM"},{"code":"00000004581","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000004654","type":"CDM"},{"code":"00000004654","type":"NDC"}],"standard_charges":[{"gross_charge":23.02,"discounted_cash":16.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004656","type":"CDM"},{"code":"00000004656","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004657","type":"CDM"},{"code":"00000004657","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE CONC 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004658","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00000004658","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE 100 MG/ML PO SOLUTION","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00000004661","type":"CDM"},{"code":"00000004661","type":"NDC"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE 10 MG/ML PO SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004662","type":"CDM"},{"code":"00000004662","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004670","type":"CDM"},{"code":"00000004670","type":"NDC"}],"standard_charges":[{"gross_charge":12.22,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VODKA LIQUID","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004673","type":"CDM"},{"code":"00000004673","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONAZEPAM 0.1 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000004706","type":"CDM"},{"code":"00000004706","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00000004708","type":"CDM"},{"code":"00000004708","type":"NDC"}],"standard_charges":[{"gross_charge":52.32,"discounted_cash":36.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004715","type":"CDM"},{"code":"00000004715","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL-SODIUM CHLORIDE IV SOLN 2 GM/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004757","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000004757","type":"NDC"}],"standard_charges":[{"gross_charge":1128.6,"discounted_cash":790.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL SOLN 10 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004761","type":"CDM"},{"code":"00000004761","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KANAMYCIN 50 MG/ML ORAL SOLUTION","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000004783","type":"CDM"},{"code":"00000004783","type":"NDC"}],"standard_charges":[{"gross_charge":316.08,"discounted_cash":221.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004815","type":"CDM"},{"code":"00000004815","type":"NDC"}],"standard_charges":[{"gross_charge":23.68,"discounted_cash":16.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL ELIXIR 20 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00000004818","type":"CDM"},{"code":"00000004818","type":"NDC"}],"standard_charges":[{"gross_charge":12.98,"discounted_cash":9.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4.0,"type":"ML"},"code_information":[{"code":"Rx00000004824","type":"CDM"},{"code":"00000004824","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000004834","type":"CDM"},{"code":"0000004834","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE 4 MG IN 500 ML NS INFUSION ONE-STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004845","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000004845","type":"NDC"}],"standard_charges":[{"gross_charge":1130.58,"discounted_cash":791.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOPROTERENOL-NACL IV SOLUTION 200 MCG/50 ML-0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004847","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000004847","type":"NDC"}],"standard_charges":[{"gross_charge":844.66,"discounted_cash":591.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE LIQUID 0.4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004866","type":"CDM"},{"code":"00000004866","type":"NDC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"UVC HEPARIN, CA GLUCONATE, DEXTROSE 10% SIMPLE WSH","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004876","type":"CDM"},{"code":"00000004876","type":"NDC"}],"standard_charges":[{"gross_charge":212.44,"discounted_cash":148.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN 0.5 UNITS/ML IN 0.45% NACL (NICU) - SIMPLE WSH","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004877","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004877","type":"NDC"}],"standard_charges":[{"gross_charge":171.49,"discounted_cash":120.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE 1% 30 ML + EPINEPHRINE (1:1000) 1 ML IN LR 1000 ML ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004880","type":"CDM"},{"code":"00000004880","type":"NDC"}],"standard_charges":[{"gross_charge":1797.27,"discounted_cash":1258.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM 2 MG/ML PCA SYRINGE,MIDAZOLAM 60 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 100 MG/50ML IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 60 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004882","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000004882","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM INJ 0.5 MG/ML - 10 ML SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004883","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000004883","type":"NDC"}],"standard_charges":[{"gross_charge":119.89,"discounted_cash":83.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL 10 MG/ML INJ (NICU)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004884","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00000004884","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAFFEINE CITRATE ORAL SOLN 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004888","type":"CDM"},{"code":"00000004888","type":"NDC"}],"standard_charges":[{"gross_charge":24.06,"discounted_cash":16.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 0.75 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004889","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00000004889","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MINERAL OIL-GLYCERIN RE ENEM","drug_information":{"unit":240.0,"type":"ML"},"code_information":[{"code":"Rx00000004896","type":"CDM"},{"code":"00000004896","type":"NDC"}],"standard_charges":[{"gross_charge":56.01,"discounted_cash":39.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARDIAC ROTOBLATOR SOLN (NITROGLYCERIN 4 MG, HEPARIN 5000 UNIT, ROTOGP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004899","type":"CDM"},{"code":"00000004899","type":"NDC"}],"standard_charges":[{"gross_charge":4006.56,"discounted_cash":2804.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PERIPHERAL ROTOBLATOR (NITROGLYCERIN 5 MG, VERAPAMIL 5 MG, VIP [74702379]","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004900","type":"CDM"},{"code":"00000004900","type":"NDC"}],"standard_charges":[{"gross_charge":6927.84,"discounted_cash":4849.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00000004901","type":"CDM"},{"code":"00000004901","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004903","type":"CDM"},{"code":"00000004903","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN B 2 ML- METHYLENE BLUE 1 ML IN 1000 ML NS IRRI","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000004981","type":"CDM"},{"code":"00000004981","type":"NDC"}],"standard_charges":[{"gross_charge":235.84,"discounted_cash":165.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE 0.2% 10 ML WITH LIDOCAINE (PF) 1% 10 ML - ONE STEP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000005031","type":"CDM"},{"code":"00000005031","type":"NDC"}],"standard_charges":[{"gross_charge":1164.21,"discounted_cash":814.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVICAINE 0.25%-EPI 1:200000 30ML WITH LIDOCAINE 0.5% 30ML ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000005039","type":"CDM"},{"code":"00000005039","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-CH14.18 17.5 MG/5 ML IV SOLN (ANBL0032 NCT00026312)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005054","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000005054","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-BORTEZOMIB 3.5 MG INJECTION SOLR (AAML1031 NCT01371981)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005057","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000005057","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-SORAFENIB 50 MG TAB (AAML1031 NCT01371981)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005058","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00000005058","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-SORAFENIB 200 MG TAB (AAML1031 NCT01371981)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005059","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00000005059","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBAZAM SUSPENSION 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000005073","type":"CDM"},{"code":"00000005073","type":"NDC"}],"standard_charges":[{"gross_charge":29.28,"discounted_cash":20.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) IN NACL 0.9% IV SOLN 100 UNIT/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005110","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000005110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 150 MG/150ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000005118","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000005118","type":"NDC"}],"standard_charges":[{"gross_charge":138.87,"discounted_cash":97.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000005123","type":"CDM"},{"code":"00000005123","type":"NDC"}],"standard_charges":[{"gross_charge":11.48,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005133","type":"CDM"},{"code":"00000005133","type":"NDC"}],"standard_charges":[{"gross_charge":42.16,"discounted_cash":29.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 1 PARTIAL TABLET"}]},{"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":"Rx00000005137","type":"CDM"},{"code":"00000005137","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000005139","type":"CDM"},{"code":"00000005139","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000005141","type":"CDM"},{"code":"00000005141","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM HCL IV SOLN 150 MG/30ML (BASE EQUIVALENT),MIDAZOLAM HCL IV SOLN PREFILLED SYRINGE 150 MG/30ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005229","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000005229","type":"NDC"}],"standard_charges":[{"gross_charge":288.54,"discounted_cash":201.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005232","type":"CDM"},{"code":"00000005232","type":"NDC"}],"standard_charges":[{"gross_charge":32.86,"discounted_cash":23.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 1 PARTIAL TABLET"}]},{"description":"EPINEPHRINE-NACL IV SOLN 5 MG/250ML-0.9% (20 MCG/ML)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005289","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000005289","type":"NDC"}],"standard_charges":[{"gross_charge":439.75,"discounted_cash":307.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) SUSP 1250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000005338","type":"CDM"},{"code":"00000005338","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL 10-0.9 MG/500ML-% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000005356","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000005356","type":"NDC"}],"standard_charges":[{"gross_charge":262.31,"discounted_cash":183.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005433","type":"CDM"},{"code":"00000005433","type":"NDC"}],"standard_charges":[{"gross_charge":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005433","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000005433","type":"NDC"}],"standard_charges":[{"gross_charge":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALTEPLASE 20MG/20 ML INJ","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000005534","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000005534","type":"NDC"}],"standard_charges":[{"gross_charge":1797.64,"discounted_cash":1258.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 25 MG/ML PO SUSP","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000005605","type":"CDM"},{"code":"00000005605","type":"NDC"}],"standard_charges":[{"gross_charge":12.82,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 150 MG/150ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005616","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000005616","type":"NDC"}],"standard_charges":[{"gross_charge":277.74,"discounted_cash":194.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL 10 MCG/ML PCA SYRINGE,FENTANYL CITRATE-NACL SOLN PREF SYR 550 MCG/55ML-0.9%,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 500 MCG/50ML,FENTANYL CITRATE-NACL SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000005651","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000005651","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE 0.5 MG/ML INFUSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000005697","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00000005697","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE 20 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00000005757","type":"CDM"},{"code":"00000005757","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PYRAZINAMIDE 100 MG/ML ORAL SUSPENSION","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000005759","type":"CDM"},{"code":"00000005759","type":"NDC"}],"standard_charges":[{"gross_charge":98.08,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMOTRIGINE 1 MG/ML ORAL LIQUID","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000005760","type":"CDM"},{"code":"00000005760","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML ORAL LIQUID","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000005761","type":"CDM"},{"code":"00000005761","type":"NDC"}],"standard_charges":[{"gross_charge":793.83,"discounted_cash":555.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VECURONIUM BROMIDE 1 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000005763","type":"CDM"},{"code":"00000005763","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL 10 MCG/ML PCA SYRINGE,FENTANYL CITRATE-NACL SOLN PREF SYR 550 MCG/55ML-0.9%,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 500 MCG/50ML,FENTANYL CITRATE-NACL SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000005764","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000005764","type":"NDC"}],"standard_charges":[{"gross_charge":154.3,"discounted_cash":108.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00000005778","type":"CDM"},{"code":"00000005778","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE HCL-NACL IV SOLN 2500 MG/250ML-0.9% (10MG/ML),KETAMINE HCL-NACL IV SOLN 1000 MG/100ML-0.69%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005806","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000005806","type":"NDC"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-GUSELKUMAB/PLACEBO 100 MG/ML SUBQ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005820","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000005820","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-CENICRIVIROC/PLACEBO 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005881","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000005881","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-INFLIXIMAB/PLACEBO 10 MG/ML IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005882","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000005882","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIAZEPAM ORAL SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000005885","type":"CDM"},{"code":"00000005885","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005889","type":"CDM"},{"code":"00000005889","type":"NDC"}],"standard_charges":[{"gross_charge":385.75,"discounted_cash":270.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BOSENTAN 6.25 MG/ML ORAL SUSPENSION (FROM TABLETS)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000005903","type":"CDM"},{"code":"00000005903","type":"NDC"}],"standard_charges":[{"gross_charge":172.94,"discounted_cash":121.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION FISH OIL AND PLANT BASED IV EMUL 20%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005904","type":"CDM"},{"code":"00000005904","type":"NDC"}],"standard_charges":[{"gross_charge":259.22,"discounted_cash":181.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE 10 MCG/ML SUSPENSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000005980","type":"CDM"},{"code":"00000005980","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-LUVELTAMAB TAZEVIBULIN (STRO-002) 10MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006211","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000006211","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SELENIOUS ACID INJ (SELENIUM EQUIV)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000006252","type":"CDM"},{"code":"00000006252","type":"NDC"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":556.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENICILLIN G POTASSIUM INJ 60000 UNIT/ML IN DEXTROSE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006266","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000006266","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFASALAZINE","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000006299","type":"CDM"},{"code":"00000006299","type":"NDC"}],"standard_charges":[{"gross_charge":28.82,"discounted_cash":20.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-IXT-M200 20 MG/ML INFUSION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006341","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000006341","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000006377","type":"CDM"},{"code":"00000006377","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIFAMPIN 25 MG/ML PO SUSP","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx00000006451","type":"CDM"},{"code":"00000006451","type":"NDC"}],"standard_charges":[{"gross_charge":11.47,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIFAXIMIN","drug_information":{"unit":220.0,"type":"ML"},"code_information":[{"code":"Rx00000006452","type":"CDM"},{"code":"00000006452","type":"NDC"}],"standard_charges":[{"gross_charge":660.13,"discounted_cash":462.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-AR-501 (GALLIUM CITRATE)/PLACEBO 2 MG/ML INHAL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006524","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000006524","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-AR-501 (GALLIUM CITRATE)/PLACEBO 10 MG/ML INHAL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006525","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000006525","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM ACETATE 0.078 MEQ/ML + HEPARIN 0.5 UNIT/ML IN STERILE WATER ARTERIAL LINE","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000006527","type":"CDM"},{"code":"00000006527","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL 50 MG/ML ORAL SUSPENSION","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00000006737","type":"CDM"},{"code":"00000006737","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE 100 MCG/ML PCA SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000006778","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00000006778","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE 0.5 MG/ML INFUSION","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000006779","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00000006779","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TPN NICU MAR ENTRY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006814","type":"CDM"},{"code":"00000006814","type":"NDC"}],"standard_charges":[{"gross_charge":165.42,"discounted_cash":115.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000006856","type":"CDM"},{"code":"00000006856","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":1.6,"type":"ML"},"code_information":[{"code":"Rx00000006857","type":"CDM"},{"code":"00000006857","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000006858","type":"CDM"},{"code":"00000006858","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000006863","type":"CDM"},{"code":"00000006863","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT 66.7 MG/ML ORAL SUSPENSION","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000006887","type":"CDM"},{"code":"00000006887","type":"NDC"}],"standard_charges":[{"gross_charge":92.99,"discounted_cash":65.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-CLESROVIMAB (MK-1654) PALIVIZUMAB/PLACEBO IM INJECTION (DOSE BLINDED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006944","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000006944","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN 1 MG/ML COMPOUNDED ORAL SUSPENSION (DESENSITIZATION PROTOCOL)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00000006951","type":"CDM"},{"code":"00000006951","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000007048","type":"CDM"},{"code":"00000007048","type":"NDC"}],"standard_charges":[{"gross_charge":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOPAMINE INJ 1.6 MG/ML IN D5W","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000007057","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00000007057","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-ACR-368 3.3 MG/ML IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000007149","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000007149","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LANSOPRAZOLE SUSP 3 MG/ML (COMPOUND KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000007195","type":"CDM"},{"code":"00000007195","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":9.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACID-CALCIUM-HEPARIN INFUSION 3% IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000007201","type":"CDM"},{"code":"00000007201","type":"NDC"}],"standard_charges":[{"gross_charge":1294.92,"discounted_cash":906.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-OLVI-VEC INTRAPERITON INFUSION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000007209","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000007209","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000007214","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00000007214","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE HCL INJ,KETAMINE HCL-NACL IV SOLN 500 MG/250ML-0.9% (2MG/ML),KETAMINE HCL-NACL IV SOLN 100 MG/50ML-0.85%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000007357","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000007357","type":"NDC"}],"standard_charges":[{"gross_charge":1801.8,"discounted_cash":1261.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"STUDY-MILVEXIAN/PLACEBO PO TABS (DOSE BLINDED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000007392","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000007392","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE HCL INJ,KETAMINE HCL-NACL IV SOLN 500 MG/250ML-0.9% (2MG/ML),KETAMINE HCL-NACL IV SOLN 100 MG/50ML-0.85%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000007617","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000007617","type":"NDC"}],"standard_charges":[{"gross_charge":900.9,"discounted_cash":630.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000007828","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00000007828","type":"NDC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE BENZOATE FOR SUSP 50 MG/ML (CMPD KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000007869","type":"CDM"},{"code":"00000007869","type":"NDC"}],"standard_charges":[{"gross_charge":14.41,"discounted_cash":10.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VITAMIN A PALMITATE (BULK) LIQUID","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000008129","type":"CDM"},{"code":"00000008129","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":13.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIMODIPINE 30 MG/ML (CONCENTRATE) PO LIQUID","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000008331","type":"CDM"},{"code":"00000008331","type":"NDC"}],"standard_charges":[{"gross_charge":14.29,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE 100 MCG/ML PCA SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000008345","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00000008345","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN 4 MG/ML ORAL SUSPENSION","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000008402","type":"CDM"},{"code":"00000008402","type":"NDC"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL 10 MCG/ML PCA SYRINGE,FENTANYL CITRATE-NACL SOLN PREF SYR 550 MCG/55ML-0.9%,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 500 MCG/50ML,FENTANYL CITRATE-NACL SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000086810","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000086810","type":"NDC"}],"standard_charges":[{"gross_charge":141.33,"discounted_cash":98.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE 5 MG/ML PCA","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000091850","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000091850","type":"NDC"}],"standard_charges":[{"gross_charge":1407.86,"discounted_cash":985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRISMASATE B22GK 4/0 DIALYSIS SOLUTION","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000113917","type":"CDM"},{"code":"00000113917","type":"NDC"}],"standard_charges":[{"gross_charge":192.94,"discounted_cash":135.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATOMOXETINE HCL CAP 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002322730","type":"CDM"},{"code":"00002322730","type":"NDC"}],"standard_charges":[{"gross_charge":32.71,"discounted_cash":22.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATOMOXETINE HCL CAP 25 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002322830","type":"CDM"},{"code":"00002322830","type":"NDC"}],"standard_charges":[{"gross_charge":32.71,"discounted_cash":22.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATOMOXETINE HCL CAP 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002322930","type":"CDM"},{"code":"00002322930","type":"NDC"}],"standard_charges":[{"gross_charge":34.66,"discounted_cash":24.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002323560","type":"CDM"},{"code":"00002323560","type":"NDC"}],"standard_charges":[{"gross_charge":24.41,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATOMOXETINE HCL CAP 18 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002323830","type":"CDM"},{"code":"00002323830","type":"NDC"}],"standard_charges":[{"gross_charge":32.71,"discounted_cash":22.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002411230","type":"CDM"},{"code":"00002411230","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002416530","type":"CDM"},{"code":"00002416530","type":"NDC"}],"standard_charges":[{"gross_charge":21.64,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BARICITINIB TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002418230","type":"CDM"},{"code":"00002418230","type":"NDC"}],"standard_charges":[{"gross_charge":165.91,"discounted_cash":116.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRASUGREL HCL TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002475901","type":"CDM"},{"code":"00002475901","type":"NDC"}],"standard_charges":[{"gross_charge":20.96,"discounted_cash":14.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRASUGREL HCL TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002512301","type":"CDM"},{"code":"00002512301","type":"NDC"}],"standard_charges":[{"gross_charge":36.64,"discounted_cash":25.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00002751017","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751017","type":"NDC"}],"standard_charges":[{"gross_charge":191.96,"discounted_cash":134.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00002751017","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00002751017","type":"NDC"}],"standard_charges":[{"gross_charge":191.96,"discounted_cash":134.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO PROT & LISPRO INJ 100 UNIT/ML (75-25)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002751101","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751101","type":"NDC"}],"standard_charges":[{"gross_charge":728.75,"discounted_cash":510.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO PROTAMINE & LISPRO INJ 100 UNIT/ML (50-50)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002751201","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751201","type":"NDC"}],"standard_charges":[{"gross_charge":729.06,"discounted_cash":510.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002753301","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002753301","type":"NDC"}],"standard_charges":[{"gross_charge":275.42,"discounted_cash":192.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BEBTELOVIMAB IV SOLN 175 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00002758901","type":"CDM"},{"code":"00002758901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002759701","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00002759701","type":"NDC"}],"standard_charges":[{"gross_charge":732.67,"discounted_cash":512.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14679.83,"discounted_cash":10275.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2935.98,"discounted_cash":2055.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5913.42,"discounted_cash":4139.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002771401","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002771401","type":"NDC"}],"standard_charges":[{"gross_charge":301.81,"discounted_cash":211.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002771459","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002771459","type":"NDC"}],"standard_charges":[{"gross_charge":275.47,"discounted_cash":192.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002775201","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002775201","type":"NDC"}],"standard_charges":[{"gross_charge":758.55,"discounted_cash":530.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002775205","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002775205","type":"NDC"}],"standard_charges":[{"gross_charge":275.47,"discounted_cash":192.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":340.07,"discounted_cash":238.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002831501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002831501","type":"NDC"}],"standard_charges":[{"gross_charge":340.07,"discounted_cash":238.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002831517","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002831517","type":"NDC"}],"standard_charges":[{"gross_charge":702.08,"discounted_cash":491.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 500 UNIT/ML,INSULIN REGULAR (HUMAN) SOLN PEN-INJECTOR 500 UNIT/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00002850101","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002850101","type":"NDC"}],"standard_charges":[{"gross_charge":5345.2,"discounted_cash":3741.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002871501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002871501","type":"NDC"}],"standard_charges":[{"gross_charge":340.07,"discounted_cash":238.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00003029305","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00003029305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3740.46,"discounted_cash":2618.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5798.49,"discounted_cash":4058.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":35677.5,"discounted_cash":24974.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":142709.68,"discounted_cash":99896.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003256016","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00003256016","type":"NDC"}],"standard_charges":[{"gross_charge":433.35,"discounted_cash":303.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003257016","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00003257016","type":"NDC"}],"standard_charges":[{"gross_charge":867.07,"discounted_cash":606.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":31297.33,"discounted_cash":21908.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIVOLUMAB IV SOLN 120 MG/12ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx00003375614","type":"CDM"},{"code":"J9299","type":"HCPCS"},{"code":"00003375614","type":"NDC"}],"standard_charges":[{"gross_charge":15648.62,"discounted_cash":10954.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13040.47,"discounted_cash":9128.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SAXAGLIPTIN HCL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003421511","type":"CDM"},{"code":"00003421511","type":"NDC"}],"standard_charges":[{"gross_charge":25.64,"discounted_cash":17.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00004026129","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00004026129","type":"NDC"}],"standard_charges":[{"gross_charge":24.54,"discounted_cash":17.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004029809","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"00004029809","type":"NDC"}],"standard_charges":[{"gross_charge":1007.47,"discounted_cash":705.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":36.16,"discounted_cash":25.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAPECITABINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004110150","type":"CDM"},{"code":"J8522","type":"HCPCS"},{"code":"00004110150","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MENINGOCOCCAL GROUP B VAC (RECOMB) IM SUSP PREFILLED SYR","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005010005","type":"CDM"},{"code":"00005010005","type":"NDC"}],"standard_charges":[{"gross_charge":2091.29,"discounted_cash":1463.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":868.71,"discounted_cash":608.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":868.71,"discounted_cash":608.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":69.65,"discounted_cash":48.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006027501","type":"CDM"},{"code":"00006027501","type":"NDC"}],"standard_charges":[{"gross_charge":18.64,"discounted_cash":13.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006046102","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00006046102","type":"NDC"}],"standard_charges":[{"gross_charge":388.04,"discounted_cash":271.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006046201","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00006046201","type":"NDC"}],"standard_charges":[{"gross_charge":553.22,"discounted_cash":387.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006046206","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00006046206","type":"NDC"}],"standard_charges":[{"gross_charge":553.22,"discounted_cash":387.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006071101","type":"CDM"},{"code":"00006071101","type":"NDC"}],"standard_charges":[{"gross_charge":18.64,"discounted_cash":13.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006095154","type":"CDM"},{"code":"00006095154","type":"NDC"}],"standard_charges":[{"gross_charge":14.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":23702.97,"discounted_cash":16592.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":23702.97,"discounted_cash":16592.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEMBROLIZUMAB IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00006302604","type":"CDM"},{"code":"J9271","type":"HCPCS"},{"code":"00006302604","type":"NDC"}],"standard_charges":[{"gross_charge":23702.97,"discounted_cash":16592.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006306100","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00006306100","type":"NDC"}],"standard_charges":[{"gross_charge":1251.66,"discounted_cash":876.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006306101","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00006306101","type":"NDC"}],"standard_charges":[{"gross_charge":1265.28,"discounted_cash":885.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT FOR ORAL SUSP 125 MG (125 MG/5ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006306601","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00006306601","type":"NDC"}],"standard_charges":[{"gross_charge":550.32,"discounted_cash":385.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT FOR ORAL SUSP 125 MG (125 MG/5ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006306603","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00006306603","type":"NDC"}],"standard_charges":[{"gross_charge":596.21,"discounted_cash":417.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM PACKET FOR SUSP 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006360361","type":"CDM"},{"code":"00006360361","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006384371","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"00006384371","type":"NDC"}],"standard_charges":[{"gross_charge":1536.97,"discounted_cash":1075.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMIPEN-CILASTAT-RELEBACT FOR IV SOLN 1.25 GM (500-500-250MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006385601","type":"CDM"},{"code":"J0742","type":"HCPCS"},{"code":"00006385601","type":"NDC"}],"standard_charges":[{"gross_charge":1118.53,"discounted_cash":782.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMIPEN-CILASTAT-RELEBACT FOR IV SOLN 1.25 GM (500-500-250MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006385602","type":"CDM"},{"code":"J0742","type":"HCPCS"},{"code":"00006385602","type":"NDC"}],"standard_charges":[{"gross_charge":1182.65,"discounted_cash":827.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006394101","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00006394101","type":"NDC"}],"standard_charges":[{"gross_charge":1118.77,"discounted_cash":783.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006394132","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00006394132","type":"NDC"}],"standard_charges":[{"gross_charge":1167.28,"discounted_cash":817.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HUMAN PAPILLOMAVIRUS (HPV) 9-VALENT RECOMB VAC SUSP PREF SYR","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006412101","type":"CDM"},{"code":"90651","type":"HCPCS"},{"code":"00006412101","type":"NDC"}],"standard_charges":[{"gross_charge":1075.77,"discounted_cash":753.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006430501","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"00006430501","type":"NDC"}],"standard_charges":[{"gross_charge":1796.34,"discounted_cash":1257.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006430502","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"00006430502","type":"NDC"}],"standard_charges":[{"gross_charge":1796.34,"discounted_cash":1257.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PNEUMOCOCCAL 15-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006432901","type":"CDM"},{"code":"90671","type":"HCPCS"},{"code":"00006432901","type":"NDC"}],"standard_charges":[{"gross_charge":2459.93,"discounted_cash":1721.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PNEUMOCOCCAL 15-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006432902","type":"CDM"},{"code":"90671","type":"HCPCS"},{"code":"00006432902","type":"NDC"}],"standard_charges":[{"gross_charge":2459.93,"discounted_cash":1721.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":246.65,"discounted_cash":172.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":246.65,"discounted_cash":172.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VARICELLA VIRUS VAC LIVE FOR INJ 1350 PFU/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006482601","type":"CDM"},{"code":"90716","type":"HCPCS"},{"code":"00006482601","type":"NDC"}],"standard_charges":[{"gross_charge":728.53,"discounted_cash":509.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1750.56,"discounted_cash":1225.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1151.77,"discounted_cash":806.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1613.94,"discounted_cash":1129.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":932.79,"discounted_cash":652.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00007323201","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"00007323201","type":"NDC"}],"standard_charges":[{"gross_charge":850.96,"discounted_cash":595.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx00007323601","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"00007323601","type":"NDC"}],"standard_charges":[{"gross_charge":850.96,"discounted_cash":595.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008060704","type":"CDM"},{"code":"00008060704","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008083321","type":"CDM"},{"code":"00008083321","type":"NDC"}],"standard_charges":[{"gross_charge":42.98,"discounted_cash":30.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008083322","type":"CDM"},{"code":"00008083322","type":"NDC"}],"standard_charges":[{"gross_charge":42.98,"discounted_cash":30.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008083620","type":"CDM"},{"code":"00008083620","type":"NDC"}],"standard_charges":[{"gross_charge":32.47,"discounted_cash":22.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092351","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092351","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092360","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092360","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SIROLIMUS ORAL SOLN 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00008103004","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"00008103004","type":"NDC"}],"standard_charges":[{"gross_charge":62.58,"discounted_cash":43.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SIROLIMUS ORAL SOLN 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00008103006","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"00008103006","type":"NDC"}],"standard_charges":[{"gross_charge":66.27,"discounted_cash":46.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SIROLIMUS TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008104110","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"00008104110","type":"NDC"}],"standard_charges":[{"gross_charge":65.02,"discounted_cash":45.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMSIROLIMUS SOLN FOR IV INFUSION 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00008117901","type":"CDM"},{"code":"J9330","type":"HCPCS"},{"code":"00008117901","type":"NDC"}],"standard_charges":[{"gross_charge":7262.99,"discounted_cash":5084.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESVENLAFAXINE SUCCINATE TAB ER 24HR 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008121101","type":"CDM"},{"code":"00008121101","type":"NDC"}],"standard_charges":[{"gross_charge":35.14,"discounted_cash":24.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESVENLAFAXINE SUCCINATE TAB ER 24HR 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008121114","type":"CDM"},{"code":"00008121114","type":"NDC"}],"standard_charges":[{"gross_charge":35.34,"discounted_cash":24.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESVENLAFAXINE SUCCINATE TAB ER 24HR 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008121130","type":"CDM"},{"code":"00008121130","type":"NDC"}],"standard_charges":[{"gross_charge":35.15,"discounted_cash":24.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESVENLAFAXINE SUCCINATE TAB ER 24HR 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008121150","type":"CDM"},{"code":"00008121150","type":"NDC"}],"standard_charges":[{"gross_charge":30.35,"discounted_cash":21.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GEMTUZUMAB OZOGAMICIN FOR IV SOLN 4.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008451001","type":"CDM"},{"code":"J9203","type":"HCPCS"},{"code":"00008451001","type":"NDC"}],"standard_charges":[{"gross_charge":40173.01,"discounted_cash":28121.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008499001","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"00008499001","type":"NDC"}],"standard_charges":[{"gross_charge":1148.45,"discounted_cash":803.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008499019","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"00008499019","type":"NDC"}],"standard_charges":[{"gross_charge":1148.45,"discounted_cash":803.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008499020","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"00008499020","type":"NDC"}],"standard_charges":[{"gross_charge":1020.49,"discounted_cash":714.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":347.25,"discounted_cash":243.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":344.28,"discounted_cash":241.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":645.54,"discounted_cash":451.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001306","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001306","type":"NDC"}],"standard_charges":[{"gross_charge":577.63,"discounted_cash":404.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001612","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001612","type":"NDC"}],"standard_charges":[{"gross_charge":1033.62,"discounted_cash":723.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.03,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":168.26,"discounted_cash":117.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARGININE HCL INJ 10%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009043601","type":"CDM"},{"code":"00009043601","type":"NDC"}],"standard_charges":[{"gross_charge":610.56,"discounted_cash":427.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":640.45,"discounted_cash":448.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009072805","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009072805","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009074630","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00009074630","type":"NDC"}],"standard_charges":[{"gross_charge":767.33,"discounted_cash":537.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009075801","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009075801","type":"NDC"}],"standard_charges":[{"gross_charge":353.29,"discounted_cash":247.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009076004","type":"CDM"},{"code":"00009076004","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009077520","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009077520","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009077526","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009077526","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":275.54,"discounted_cash":192.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 2000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009085001","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009085001","type":"NDC"}],"standard_charges":[{"gross_charge":1207.14,"discounted_cash":845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1911.64,"discounted_cash":1338.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":969.3,"discounted_cash":678.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00009307303","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009307303","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1535.87,"discounted_cash":1075.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1971.04,"discounted_cash":1379.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009347501","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009347501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUTILIDE FUMARATE INJ 1 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00009379401","type":"CDM"},{"code":"J1742","type":"HCPCS"},{"code":"00009379401","type":"NDC"}],"standard_charges":[{"gross_charge":1043.96,"discounted_cash":730.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009454401","type":"CDM"},{"code":"00009454401","type":"NDC"}],"standard_charges":[{"gross_charge":20.03,"discounted_cash":14.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009513503","type":"CDM"},{"code":"00009513503","type":"NDC"}],"standard_charges":[{"gross_charge":203.62,"discounted_cash":142.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LINEZOLID FOR SUSP 100 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00009513601","type":"CDM"},{"code":"00009513601","type":"NDC"}],"standard_charges":[{"gross_charge":244.11,"discounted_cash":170.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","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":819.33,"discounted_cash":573.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009519004","type":"CDM"},{"code":"00009519004","type":"NDC"}],"standard_charges":[{"gross_charge":31.53,"discounted_cash":22.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009519104","type":"CDM"},{"code":"00009519104","type":"NDC"}],"standard_charges":[{"gross_charge":31.51,"discounted_cash":22.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18927.73,"discounted_cash":13249.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18933.93,"discounted_cash":13253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":705.61,"discounted_cash":493.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00013830304","type":"CDM"},{"code":"00013830304","type":"NDC"}],"standard_charges":[{"gross_charge":748.54,"discounted_cash":523.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IXABEPILONE FOR IV INFUSION 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00015191012","type":"CDM"},{"code":"J9207","type":"HCPCS"},{"code":"00015191012","type":"NDC"}],"standard_charges":[{"gross_charge":4630.23,"discounted_cash":3241.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOMUSTINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00015303020","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00015303020","type":"NDC"}],"standard_charges":[{"gross_charge":25.94,"discounted_cash":18.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETOPOSIDE PHOSPHATE IV FOR INJ 100 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00015340420","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00015340420","type":"NDC"}],"standard_charges":[{"gross_charge":1633.46,"discounted_cash":1143.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00023031204","type":"CDM"},{"code":"00023031204","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":6.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2635.68,"discounted_cash":1844.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESALAMINE CAP DR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023585318","type":"CDM"},{"code":"00023585318","type":"NDC"}],"standard_charges":[{"gross_charge":16.77,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":135.77,"discounted_cash":95.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":135.81,"discounted_cash":95.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.29,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 15000-47000-63000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023611101","type":"CDM"},{"code":"00023611101","type":"NDC"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":13.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22.23,"discounted_cash":15.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 3000-10000-14000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023611301","type":"CDM"},{"code":"00023611301","type":"NDC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":9.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 5000-17000-24000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023611501","type":"CDM"},{"code":"00023611501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00023782410","type":"CDM"},{"code":"00023782410","type":"NDC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023916330","type":"CDM"},{"code":"00023916330","type":"NDC"}],"standard_charges":[{"gross_charge":28.56,"discounted_cash":19.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00024279210","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00024279210","type":"NDC"}],"standard_charges":[{"gross_charge":463.56,"discounted_cash":324.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DRONEDARONE HCL TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024414210","type":"CDM"},{"code":"00024414210","type":"NDC"}],"standard_charges":[{"gross_charge":28.76,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4361.78,"discounted_cash":3053.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":57424.9,"discounted_cash":40197.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3152.16,"discounted_cash":2206.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6304.32,"discounted_cash":4413.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOFARABINE IV SOLN 1 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00024586001","type":"CDM"},{"code":"J9027","type":"HCPCS"},{"code":"00024586001","type":"NDC"}],"standard_charges":[{"gross_charge":12940.8,"discounted_cash":9058.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00024592605","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00024592605","type":"NDC"}],"standard_charges":[{"gross_charge":172.05,"discounted_cash":120.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025145134","type":"CDM"},{"code":"00025145134","type":"NDC"}],"standard_charges":[{"gross_charge":14.54,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 3000-9500-15000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032120370","type":"CDM"},{"code":"00032120370","type":"NDC"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 6000-19000-30000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032120601","type":"CDM"},{"code":"00032120601","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 12000-38000-60000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032121201","type":"CDM"},{"code":"00032121201","type":"NDC"}],"standard_charges":[{"gross_charge":17.24,"discounted_cash":12.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24.24,"discounted_cash":16.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032122407","type":"CDM"},{"code":"00032122407","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FELBAMATE SUSP 600 MG/5ML","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00037044267","type":"CDM"},{"code":"00037044267","type":"NDC"}],"standard_charges":[{"gross_charge":3070.34,"discounted_cash":2149.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":83.08,"discounted_cash":58.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN CHEW TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00045051924","type":"CDM"},{"code":"00045051924","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTASE TAB 9000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00045091060","type":"CDM"},{"code":"00045091060","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1409.88,"discounted_cash":986.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":208.78,"discounted_cash":146.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052022","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052022","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":185.37,"discounted_cash":129.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":741.09,"discounted_cash":518.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049319001","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"00049319001","type":"NDC"}],"standard_charges":[{"gross_charge":206.38,"discounted_cash":144.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":874.5,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049392020","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"00049392020","type":"NDC"}],"standard_charges":[{"gross_charge":939.49,"discounted_cash":657.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049392083","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"00049392083","type":"NDC"}],"standard_charges":[{"gross_charge":939.49,"discounted_cash":657.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":33.59,"discounted_cash":23.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049397041","type":"CDM"},{"code":"00049397041","type":"NDC"}],"standard_charges":[{"gross_charge":32.47,"discounted_cash":22.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049398041","type":"CDM"},{"code":"00049398041","type":"NDC"}],"standard_charges":[{"gross_charge":38.6,"discounted_cash":27.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054000725","type":"CDM"},{"code":"00054000725","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001120","type":"CDM"},{"code":"00054001120","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001121","type":"CDM"},{"code":"00054001121","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001825","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001825","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054002125","type":"CDM"},{"code":"00054002125","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054004421","type":"CDM"},{"code":"00054004421","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00054004544","type":"CDM"},{"code":"00054004544","type":"NDC"}],"standard_charges":[{"gross_charge":146.91,"discounted_cash":102.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN ORAL SOLN 0.05 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00054005746","type":"CDM"},{"code":"00054005746","type":"NDC"}],"standard_charges":[{"gross_charge":14.65,"discounted_cash":10.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054008826","type":"CDM"},{"code":"00054008826","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXCARBAZEPINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054009820","type":"CDM"},{"code":"00054009820","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXCARBAZEPINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054009825","type":"CDM"},{"code":"00054009825","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACARBOSE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054014120","type":"CDM"},{"code":"00054014120","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054017613","type":"CDM"},{"code":"00054017613","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMCICLOVIR TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054019713","type":"CDM"},{"code":"00054019713","type":"NDC"}],"standard_charges":[{"gross_charge":14.44,"discounted_cash":10.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054022225","type":"CDM"},{"code":"00054022225","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054022321","type":"CDM"},{"code":"00054022321","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023020","type":"CDM"},{"code":"00054023020","type":"NDC"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023025","type":"CDM"},{"code":"00054023025","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.83,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.11,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CODEINE SULFATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054024424","type":"CDM"},{"code":"00054024424","type":"NDC"}],"standard_charges":[{"gross_charge":13.01,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CODEINE SULFATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054024425","type":"CDM"},{"code":"00054024425","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054026913","type":"CDM"},{"code":"00054026913","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LINEZOLID FOR SUSP 100 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00054031950","type":"CDM"},{"code":"00054031950","type":"NDC"}],"standard_charges":[{"gross_charge":243.77,"discounted_cash":170.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054038225","type":"CDM"},{"code":"J8530","type":"HCPCS"},{"code":"00054038225","type":"NDC"}],"standard_charges":[{"gross_charge":23.14,"discounted_cash":16.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054038325","type":"CDM"},{"code":"J8530","type":"HCPCS"},{"code":"00054038325","type":"NDC"}],"standard_charges":[{"gross_charge":34.02,"discounted_cash":23.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00054039268","type":"CDM"},{"code":"00054039268","type":"NDC"}],"standard_charges":[{"gross_charge":99.43,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054040444","type":"CDM"},{"code":"00054040444","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054043525","type":"CDM"},{"code":"00054043525","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.02,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE SOLN 0.5 MG/5ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00054317763","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054317763","type":"NDC"}],"standard_charges":[{"gross_charge":41.91,"discounted_cash":29.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE LIQ 2.5-0.025 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054319446","type":"CDM"},{"code":"00054319446","type":"NDC"}],"standard_charges":[{"gross_charge":25.81,"discounted_cash":18.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx00054327099","type":"CDM"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00054329446","type":"CDM"},{"code":"00054329446","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00054350547","type":"CDM"},{"code":"00054350547","type":"NDC"}],"standard_charges":[{"gross_charge":157.62,"discounted_cash":110.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.81,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL SOLN 10 MG/5ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00054355663","type":"CDM"},{"code":"00054355663","type":"NDC"}],"standard_charges":[{"gross_charge":108.78,"discounted_cash":76.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054408425","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00054408425","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054418125","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054418125","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054418425","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054418425","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054429925","type":"CDM"},{"code":"00054429925","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MERCAPTOPURINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054458111","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00054458111","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054808425","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00054808425","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.83,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817425","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817425","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054830125","type":"CDM"},{"code":"00054830125","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054852725","type":"CDM"},{"code":"00054852725","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054855025","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"00054855025","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054855324","type":"CDM"},{"code":"00054855324","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBIDOPA TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056051168","type":"CDM"},{"code":"00056051168","type":"NDC"}],"standard_charges":[{"gross_charge":14.97,"discounted_cash":10.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COLLAGENASE OINT 250 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00064501030","type":"CDM"},{"code":"00064501030","type":"NDC"}],"standard_charges":[{"gross_charge":565.34,"discounted_cash":395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":90.67,"discounted_cash":63.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":836.81,"discounted_cash":585.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":918.09,"discounted_cash":642.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00065027510","type":"CDM"},{"code":"00065027510","type":"NDC"}],"standard_charges":[{"gross_charge":959.18,"discounted_cash":671.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065030355","type":"CDM"},{"code":"00065030355","type":"NDC"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":125.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPENTOLATE W/ PHENYLEPHRINE OPHTH SOLN 0.2-1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00065035902","type":"CDM"},{"code":"00065035902","type":"NDC"}],"standard_charges":[{"gross_charge":143.74,"discounted_cash":100.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPENTOLATE W/ PHENYLEPHRINE OPHTH SOLN 0.2-1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065035905","type":"CDM"},{"code":"00065035905","type":"NDC"}],"standard_charges":[{"gross_charge":214.41,"discounted_cash":150.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00065039602","type":"CDM"},{"code":"00065039602","type":"NDC"}],"standard_charges":[{"gross_charge":139.74,"discounted_cash":97.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065039605","type":"CDM"},{"code":"00065039605","type":"NDC"}],"standard_charges":[{"gross_charge":211.05,"discounted_cash":147.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":76.06,"discounted_cash":53.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065050935","type":"CDM"},{"code":"00065050935","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065051801","type":"CDM"},{"code":"00065051801","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065063136","type":"CDM"},{"code":"00065063136","type":"NDC"}],"standard_charges":[{"gross_charge":568.13,"discounted_cash":397.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065064305","type":"CDM"},{"code":"00065064305","type":"NDC"}],"standard_charges":[{"gross_charge":322.07,"discounted_cash":225.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065064435","type":"CDM"},{"code":"00065064435","type":"NDC"}],"standard_charges":[{"gross_charge":620.87,"discounted_cash":434.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065064705","type":"CDM"},{"code":"00065064705","type":"NDC"}],"standard_charges":[{"gross_charge":491.47,"discounted_cash":344.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00065064725","type":"CDM"},{"code":"00065064725","type":"NDC"}],"standard_charges":[{"gross_charge":270.6,"discounted_cash":189.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH OINT 0.3-0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065064835","type":"CDM"},{"code":"00065064835","type":"NDC"}],"standard_charges":[{"gross_charge":654.28,"discounted_cash":458.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065065435","type":"CDM"},{"code":"00065065435","type":"NDC"}],"standard_charges":[{"gross_charge":620.5,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":57.79,"discounted_cash":40.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":51.33,"discounted_cash":35.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00065080094","type":"CDM"},{"code":"00065080094","type":"NDC"}],"standard_charges":[{"gross_charge":226.17,"discounted_cash":158.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065081701","type":"CDM"},{"code":"00065081701","type":"NDC"}],"standard_charges":[{"gross_charge":210.09,"discounted_cash":147.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00065401303","type":"CDM"},{"code":"00065401303","type":"NDC"}],"standard_charges":[{"gross_charge":512.98,"discounted_cash":359.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00067512407","type":"CDM"},{"code":"00067512407","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00067512507","type":"CDM"},{"code":"00067512507","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00067512509","type":"CDM"},{"code":"00067512509","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION | NDC EA = 1 PATCH"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00067512614","type":"CDM"},{"code":"00067512614","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx00067815203","type":"CDM"},{"code":"00067815203","type":"NDC"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIFAMPIN FOR INJ 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00068059701","type":"CDM"},{"code":"J2804","type":"HCPCS"},{"code":"00068059701","type":"NDC"}],"standard_charges":[{"gross_charge":2116.89,"discounted_cash":1481.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00069005903","type":"CDM"},{"code":"J1643","type":"HCPCS"},{"code":"00069005903","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00069005904","type":"CDM"},{"code":"J1643","type":"HCPCS"},{"code":"00069005904","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIFAMPIN FOR INJ 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069011201","type":"CDM"},{"code":"J2804","type":"HCPCS"},{"code":"00069011201","type":"NDC"}],"standard_charges":[{"gross_charge":968.31,"discounted_cash":677.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BOSUTINIB TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069013501","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00069013501","type":"NDC"}],"standard_charges":[{"gross_charge":129.56,"discounted_cash":90.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069020910","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069020910","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1543.09,"discounted_cash":1080.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1013.58,"discounted_cash":709.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1013.62,"discounted_cash":709.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1621.81,"discounted_cash":1135.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1621.78,"discounted_cash":1135.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FILGRASTIM-AAFI INJ 300 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069029301","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029301","type":"NDC"}],"standard_charges":[{"gross_charge":1060.66,"discounted_cash":742.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FILGRASTIM-AAFI INJ 300 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069029310","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029310","type":"NDC"}],"standard_charges":[{"gross_charge":1013.62,"discounted_cash":709.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7257.13,"discounted_cash":5079.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8054.48,"discounted_cash":5638.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069031401","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00069031401","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":75.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069031410","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00069031410","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":75.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1713.61,"discounted_cash":1199.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILDENAFIL CITRATE IV SOLN 10 MG/12.5ML (BASE EQUIVALENT)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00069033801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00069033801","type":"NDC"}],"standard_charges":[{"gross_charge":1015.41,"discounted_cash":710.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6854.47,"discounted_cash":4798.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RSV PRE-FUSION F A&B VAC RECOMB FOR IM SOLN 120 MCG/0.5ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069034401","type":"CDM"},{"code":"90678","type":"HCPCS"},{"code":"00069034401","type":"NDC"}],"standard_charges":[{"gross_charge":745.34,"discounted_cash":521.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VARENICLINE TARTRATE TAB 0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069046856","type":"CDM"},{"code":"00069046856","type":"NDC"}],"standard_charges":[{"gross_charge":16.24,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VARENICLINE TARTRATE TAB 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069046956","type":"CDM"},{"code":"00069046956","type":"NDC"}],"standard_charges":[{"gross_charge":16.24,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1683.44,"discounted_cash":1178.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130501","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130501","type":"NDC"}],"standard_charges":[{"gross_charge":273.9,"discounted_cash":191.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130510","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130510","type":"NDC"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 3000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130601","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130601","type":"NDC"}],"standard_charges":[{"gross_charge":415.49,"discounted_cash":290.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 3000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130610","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130610","type":"NDC"}],"standard_charges":[{"gross_charge":411.01,"discounted_cash":287.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":547.83,"discounted_cash":383.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":548.0,"discounted_cash":383.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1113.76,"discounted_cash":779.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1114.13,"discounted_cash":779.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1405.77,"discounted_cash":984.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1406.23,"discounted_cash":984.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069131801","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131801","type":"NDC"}],"standard_charges":[{"gross_charge":1121.91,"discounted_cash":785.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069131810","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131810","type":"NDC"}],"standard_charges":[{"gross_charge":1114.12,"discounted_cash":779.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ELRANATAMAB-BCMM SUBCUTANEOUS SOLN 44 MG/1.1ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00069252202","type":"CDM"},{"code":"J1323","type":"HCPCS"},{"code":"00069252202","type":"NDC"}],"standard_charges":[{"gross_charge":8160.13,"discounted_cash":5712.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":884.13,"discounted_cash":618.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069315083","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"00069315083","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069315084","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"00069315084","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069419068","type":"CDM"},{"code":"00069419068","type":"NDC"}],"standard_charges":[{"gross_charge":116.17,"discounted_cash":81.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ELRANATAMAB-BCMM SUBCUTANEOUS SOLN 76 MG/1.9ML","drug_information":{"unit":1.9,"type":"ML"},"code_information":[{"code":"Rx00069449402","type":"CDM"},{"code":"J1323","type":"HCPCS"},{"code":"00069449402","type":"NDC"}],"standard_charges":[{"gross_charge":51680.85,"discounted_cash":36176.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":129.33,"discounted_cash":90.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":138.34,"discounted_cash":96.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":89.59,"discounted_cash":62.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":95.6,"discounted_cash":66.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069547101","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069547101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069580043","type":"CDM"},{"code":"00069580043","type":"NDC"}],"standard_charges":[{"gross_charge":29.65,"discounted_cash":20.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069580060","type":"CDM"},{"code":"00069580060","type":"NDC"}],"standard_charges":[{"gross_charge":28.88,"discounted_cash":20.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069580061","type":"CDM"},{"code":"00069580061","type":"NDC"}],"standard_charges":[{"gross_charge":15.94,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069581043","type":"CDM"},{"code":"00069581043","type":"NDC"}],"standard_charges":[{"gross_charge":29.65,"discounted_cash":20.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069581060","type":"CDM"},{"code":"00069581060","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":20.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069581061","type":"CDM"},{"code":"00069581061","type":"NDC"}],"standard_charges":[{"gross_charge":15.94,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 500 MCG (0.5 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069582043","type":"CDM"},{"code":"00069582043","type":"NDC"}],"standard_charges":[{"gross_charge":29.65,"discounted_cash":20.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 500 MCG (0.5 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069582060","type":"CDM"},{"code":"00069582060","type":"NDC"}],"standard_charges":[{"gross_charge":29.12,"discounted_cash":20.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 500 MCG (0.5 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069582061","type":"CDM"},{"code":"00069582061","type":"NDC"}],"standard_charges":[{"gross_charge":15.94,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":353.52,"discounted_cash":247.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":353.64,"discounted_cash":247.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":589.41,"discounted_cash":412.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.95,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":28.88,"discounted_cash":20.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":30.61,"discounted_cash":21.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101441","type":"CDM"},{"code":"00071101441","type":"NDC"}],"standard_charges":[{"gross_charge":30.62,"discounted_cash":21.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":30.61,"discounted_cash":21.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PREGABALIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101641","type":"CDM"},{"code":"00071101641","type":"NDC"}],"standard_charges":[{"gross_charge":30.61,"discounted_cash":21.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071374066","type":"CDM"},{"code":"00071374066","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENETOCLAX TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074056611","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00074056611","type":"NDC"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENETOCLAX TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074057611","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00074057611","type":"NDC"}],"standard_charges":[{"gross_charge":183.86,"discounted_cash":128.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00074156410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00074156410","type":"NDC"}],"standard_charges":[{"gross_charge":440.74,"discounted_cash":308.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":145.77,"discounted_cash":102.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLECAPREVIR-PIBRENTASVIR TAB 100-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074262528","type":"CDM"},{"code":"00074262528","type":"NDC"}],"standard_charges":[{"gross_charge":279.55,"discounted_cash":195.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.54,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RITONAVIR TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074333330","type":"CDM"},{"code":"00074333330","type":"NDC"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":17.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR INJ KIT 22.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074334603","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"00074334603","type":"NDC"}],"standard_charges":[{"gross_charge":1928.79,"discounted_cash":1350.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5035.53,"discounted_cash":3524.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2035.99,"discounted_cash":1425.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074372790","type":"CDM"},{"code":"00074372790","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074382611","type":"CDM"},{"code":"00074382611","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":11.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074434190","type":"CDM"},{"code":"00074434190","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074438010","type":"CDM"},{"code":"00074438010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00074438220","type":"CDM"},{"code":"00074438220","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074455211","type":"CDM"},{"code":"00074455211","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074455290","type":"CDM"},{"code":"00074455290","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":34303.62,"discounted_cash":24012.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074518211","type":"CDM"},{"code":"00074518211","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074662411","type":"CDM"},{"code":"00074662411","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074706811","type":"CDM"},{"code":"00074706811","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074706990","type":"CDM"},{"code":"00074706990","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074707090","type":"CDM"},{"code":"00074707090","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074726950","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00074726950","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00075062040","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"gross_charge":144.65,"discounted_cash":101.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00075062160","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062160","type":"NDC"}],"standard_charges":[{"gross_charge":181.04,"discounted_cash":126.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00075062280","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062280","type":"NDC"}],"standard_charges":[{"gross_charge":253.46,"discounted_cash":177.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00075062300","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"gross_charge":325.86,"discounted_cash":228.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00075062430","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062430","type":"NDC"}],"standard_charges":[{"gross_charge":108.5,"discounted_cash":75.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ 300 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00075062603","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062603","type":"NDC"}],"standard_charges":[{"gross_charge":1177.37,"discounted_cash":824.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00075291201","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075291201","type":"NDC"}],"standard_charges":[{"gross_charge":398.42,"discounted_cash":278.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00075291501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075291501","type":"NDC"}],"standard_charges":[{"gross_charge":470.86,"discounted_cash":329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE IV SOLN 50 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00078010961","type":"CDM"},{"code":"J7516","type":"HCPCS"},{"code":"00078010961","type":"NDC"}],"standard_charges":[{"gross_charge":887.06,"discounted_cash":620.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00078027422","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00078027422","type":"NDC"}],"standard_charges":[{"gross_charge":32.09,"discounted_cash":22.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078032444","type":"CDM"},{"code":"00078032444","type":"NDC"}],"standard_charges":[{"gross_charge":20.14,"discounted_cash":14.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078032705","type":"CDM"},{"code":"00078032705","type":"NDC"}],"standard_charges":[{"gross_charge":19.88,"discounted_cash":13.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BASILIXIMAB FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078033184","type":"CDM"},{"code":"J0480","type":"HCPCS"},{"code":"00078033184","type":"NDC"}],"standard_charges":[{"gross_charge":17396.75,"discounted_cash":12177.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078035205","type":"CDM"},{"code":"00078035205","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXCARBAZEPINE SUSP 300 MG/5ML (60 MG/ML)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00078035752","type":"CDM"},{"code":"00078035752","type":"NDC"}],"standard_charges":[{"gross_charge":18.51,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078035834","type":"CDM"},{"code":"00078035834","type":"NDC"}],"standard_charges":[{"gross_charge":26.36,"discounted_cash":18.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078038566","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00078038566","type":"NDC"}],"standard_charges":[{"gross_charge":22.9,"discounted_cash":16.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 360 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078038666","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00078038666","type":"NDC"}],"standard_charges":[{"gross_charge":35.69,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMATINIB MESYLATE TAB 100 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078040134","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078040134","type":"NDC"}],"standard_charges":[{"gross_charge":170.67,"discounted_cash":119.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMETHYLPHENIDATE HCL CAP ER 24 HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078043005","type":"CDM"},{"code":"00078043005","type":"NDC"}],"standard_charges":[{"gross_charge":19.96,"discounted_cash":13.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMATINIB MESYLATE TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078043815","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078043815","type":"NDC"}],"standard_charges":[{"gross_charge":499.12,"discounted_cash":349.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078044005","type":"CDM"},{"code":"00078044005","type":"NDC"}],"standard_charges":[{"gross_charge":13.57,"discounted_cash":9.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00078047397","type":"CDM"},{"code":"00078047397","type":"NDC"}],"standard_charges":[{"gross_charge":8.17,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALDESLEUKIN FOR IV SOLN 22000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078049561","type":"CDM"},{"code":"J9015","type":"HCPCS"},{"code":"00078049561","type":"NDC"}],"standard_charges":[{"gross_charge":4477.8,"discounted_cash":3134.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078051005","type":"CDM"},{"code":"00078051005","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARTEMETHER-LUMEFANTRINE TAB 20-120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078056845","type":"CDM"},{"code":"00078056845","type":"NDC"}],"standard_charges":[{"gross_charge":19.74,"discounted_cash":13.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMATINIB MESYLATE TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078064930","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078064930","type":"NDC"}],"standard_charges":[{"gross_charge":588.58,"discounted_cash":412.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":30.27,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NELARABINE IV SOLN 5 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00078068361","type":"CDM"},{"code":"J9261","type":"HCPCS"},{"code":"00078068361","type":"NDC"}],"standard_charges":[{"gross_charge":2934.36,"discounted_cash":2054.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":30.27,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDOSTAURIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069802","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078069802","type":"NDC"}],"standard_charges":[{"gross_charge":244.43,"discounted_cash":171.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDOSTAURIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069899","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078069899","type":"NDC"}],"standard_charges":[{"gross_charge":383.75,"discounted_cash":268.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":86811.91,"discounted_cash":60768.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 49-51 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078077720","type":"CDM"},{"code":"00078077720","type":"NDC"}],"standard_charges":[{"gross_charge":30.27,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 49-51 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078077767","type":"CDM"},{"code":"00078077767","type":"NDC"}],"standard_charges":[{"gross_charge":30.27,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":789.86,"discounted_cash":552.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17096.66,"discounted_cash":11967.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":25600.93,"discounted_cash":17920.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00078084101","type":"CDM"},{"code":"00078084101","type":"NDC"}],"standard_charges":[{"gross_charge":768.12,"discounted_cash":537.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH OINT 0.3-0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00078087601","type":"CDM"},{"code":"00078087601","type":"NDC"}],"standard_charges":[{"gross_charge":837.64,"discounted_cash":586.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OINT","drug_information":{"unit":28.3,"type":"GM"},"code_information":[{"code":"Rx00081079887","type":"CDM"},{"code":"00081079887","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00085056605","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00085056605","type":"NDC"}],"standard_charges":[{"gross_charge":104.68,"discounted_cash":73.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00085113601","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085113601","type":"NDC"}],"standard_charges":[{"gross_charge":2051.42,"discounted_cash":1435.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POSACONAZOLE SUSP 40 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00085132801","type":"CDM"},{"code":"00085132801","type":"NDC"}],"standard_charges":[{"gross_charge":68.91,"discounted_cash":48.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085134102","type":"CDM"},{"code":"00085134102","type":"NDC"}],"standard_charges":[{"gross_charge":650.39,"discounted_cash":455.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085134106","type":"CDM"},{"code":"00085134106","type":"NDC"}],"standard_charges":[{"gross_charge":247.79,"discounted_cash":173.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 110 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085146102","type":"CDM"},{"code":"00085146102","type":"NDC"}],"standard_charges":[{"gross_charge":523.9,"discounted_cash":366.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMOZOLOMIDE CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085151905","type":"CDM"},{"code":"J8700","type":"HCPCS"},{"code":"00085151905","type":"NDC"}],"standard_charges":[{"gross_charge":111.92,"discounted_cash":78.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.3 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085331504","type":"CDM"},{"code":"00085331504","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":12.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.3 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085331530","type":"CDM"},{"code":"00085331530","type":"NDC"}],"standard_charges":[{"gross_charge":19.82,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.3 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085331535","type":"CDM"},{"code":"00085331535","type":"NDC"}],"standard_charges":[{"gross_charge":19.79,"discounted_cash":13.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMIN DROPS","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00087040203","type":"CDM"},{"code":"00087040203","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS W/ IRON DROPS 11 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00087040501","type":"CDM"},{"code":"00087040501","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLECALCIFEROL ORAL LIQUID 10 MCG/ML (400 UNIT/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00087086644","type":"CDM"},{"code":"00087086644","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN GLARGINE INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00088222033","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088222033","type":"NDC"}],"standard_charges":[{"gross_charge":867.62,"discounted_cash":607.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093001806","type":"CDM"},{"code":"00093001806","type":"NDC"}],"standard_charges":[{"gross_charge":14.77,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093013201","type":"CDM"},{"code":"00093013201","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093014719","type":"CDM"},{"code":"00093014719","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093014901","type":"CDM"},{"code":"00093014901","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093022001","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00093022001","type":"NDC"}],"standard_charges":[{"gross_charge":11.32,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093022056","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00093022056","type":"NDC"}],"standard_charges":[{"gross_charge":11.32,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00093026215","type":"CDM"},{"code":"00093026215","type":"NDC"}],"standard_charges":[{"gross_charge":148.07,"discounted_cash":103.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031101","type":"CDM"},{"code":"00093031101","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCITRIOL CAP 0.5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093065801","type":"CDM"},{"code":"00093065801","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":7.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093075201","type":"CDM"},{"code":"00093075201","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081201","type":"CDM"},{"code":"00093081201","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081205","type":"CDM"},{"code":"00093081205","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081901","type":"CDM"},{"code":"00093081901","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093100301","type":"CDM"},{"code":"00093100301","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx00093101042","type":"CDM"},{"code":"00093101042","type":"NDC"}],"standard_charges":[{"gross_charge":74.88,"discounted_cash":52.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093106001","type":"CDM"},{"code":"00093106001","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093106101","type":"CDM"},{"code":"00093106101","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN SULFATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093117701","type":"CDM"},{"code":"00093117701","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093171501","type":"CDM"},{"code":"00093171501","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx00093202631","type":"CDM"},{"code":"00093202631","type":"NDC"}],"standard_charges":[{"gross_charge":19.47,"discounted_cash":13.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093205098","type":"CDM"},{"code":"00093205098","type":"NDC"}],"standard_charges":[{"gross_charge":16.79,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093205506","type":"CDM"},{"code":"00093205506","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093213101","type":"CDM"},{"code":"00093213101","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIMETHOPRIM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093215801","type":"CDM"},{"code":"00093215801","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220301","type":"CDM"},{"code":"00093220301","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220401","type":"CDM"},{"code":"00093220401","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093292919","type":"CDM"},{"code":"00093292919","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093304006","type":"CDM"},{"code":"00093304006","type":"NDC"}],"standard_charges":[{"gross_charge":19.76,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RASAGILINE MESYLATE TAB 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093306156","type":"CDM"},{"code":"00093306156","type":"NDC"}],"standard_charges":[{"gross_charge":22.07,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093310919","type":"CDM"},{"code":"00093310919","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312501","type":"CDM"},{"code":"00093312501","type":"NDC"}],"standard_charges":[{"gross_charge":12.49,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312701","type":"CDM"},{"code":"00093312701","type":"NDC"}],"standard_charges":[{"gross_charge":13.53,"discounted_cash":9.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312901","type":"CDM"},{"code":"00093312901","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093314501","type":"CDM"},{"code":"00093314501","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093314701","type":"CDM"},{"code":"00093314701","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093316501","type":"CDM"},{"code":"00093316501","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 7.5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093323940","type":"CDM"},{"code":"00093323940","type":"NDC"}],"standard_charges":[{"gross_charge":94.92,"discounted_cash":66.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093365522","type":"CDM"},{"code":"00093365522","type":"NDC"}],"standard_charges":[{"gross_charge":44.18,"discounted_cash":30.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":76.53,"discounted_cash":53.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 10 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093365721","type":"CDM"},{"code":"00093365721","type":"NDC"}],"standard_charges":[{"gross_charge":100.97,"discounted_cash":70.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx00093413664","type":"CDM"},{"code":"00093413664","type":"NDC"}],"standard_charges":[{"gross_charge":23.42,"discounted_cash":16.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414604","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414604","type":"NDC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":9.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414664","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414664","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093414719","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"00093414719","type":"NDC"}],"standard_charges":[{"gross_charge":19.52,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093415580","type":"CDM"},{"code":"00093415580","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093416176","type":"CDM"},{"code":"00093416176","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093417773","type":"CDM"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093440519","type":"CDM"},{"code":"00093440519","type":"NDC"}],"standard_charges":[{"gross_charge":15.85,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093440593","type":"CDM"},{"code":"00093440593","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093524519","type":"CDM"},{"code":"00093524519","type":"NDC"}],"standard_charges":[{"gross_charge":13.21,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093524719","type":"CDM"},{"code":"00093524719","type":"NDC"}],"standard_charges":[{"gross_charge":16.88,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093524819","type":"CDM"},{"code":"00093524819","type":"NDC"}],"standard_charges":[{"gross_charge":18.98,"discounted_cash":13.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093528501","type":"CDM"},{"code":"00093528501","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093529056","type":"CDM"},{"code":"00093529056","type":"NDC"}],"standard_charges":[{"gross_charge":45.92,"discounted_cash":32.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093565556","type":"CDM"},{"code":"00093565556","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx00093613832","type":"CDM"},{"code":"00093613832","type":"NDC"}],"standard_charges":[{"gross_charge":791.36,"discounted_cash":553.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.78,"discounted_cash":9.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":23.03,"discounted_cash":16.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.12,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":25.31,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093711498","type":"CDM"},{"code":"00093711498","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx00093714931","type":"CDM"},{"code":"00093714931","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093731601","type":"CDM"},{"code":"00093731601","type":"NDC"}],"standard_charges":[{"gross_charge":16.77,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE SPRINKLE CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093733506","type":"CDM"},{"code":"00093733506","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE SPRINKLE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093733606","type":"CDM"},{"code":"00093733606","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":8.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCITRIOL CAP 0.5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093735301","type":"CDM"},{"code":"00093735301","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093738598","type":"CDM"},{"code":"00093738598","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093738698","type":"CDM"},{"code":"00093738698","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093762056","type":"CDM"},{"code":"00093762056","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093777201","type":"CDM"},{"code":"00093777201","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093777219","type":"CDM"},{"code":"00093777219","type":"NDC"}],"standard_charges":[{"gross_charge":16.53,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093777293","type":"CDM"},{"code":"00093777293","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL CITRATE LOZENGE ON A HANDLE 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093786565","type":"CDM"},{"code":"00093786565","type":"NDC"}],"standard_charges":[{"gross_charge":28.23,"discounted_cash":19.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMCICLOVIR TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093811856","type":"CDM"},{"code":"00093811856","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093867574","type":"CDM"},{"code":"00093867574","type":"NDC"}],"standard_charges":[{"gross_charge":13.27,"discounted_cash":9.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093867575","type":"CDM"},{"code":"00093867575","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.36,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEXILETINE HCL CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093874001","type":"CDM"},{"code":"00093874001","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEXILETINE HCL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093874101","type":"CDM"},{"code":"00093874101","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093894301","type":"CDM"},{"code":"00093894301","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.46,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETHOSUXIMIDE SOLN 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093966016","type":"CDM"},{"code":"00093966016","type":"NDC"}],"standard_charges":[{"gross_charge":13.54,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115136529","type":"CDM"},{"code":"00115136529","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115136530","type":"CDM"},{"code":"00115136530","type":"NDC"}],"standard_charges":[{"gross_charge":13.12,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115148601","type":"CDM"},{"code":"00115148601","type":"NDC"}],"standard_charges":[{"gross_charge":13.56,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115148701","type":"CDM"},{"code":"00115148701","type":"NDC"}],"standard_charges":[{"gross_charge":13.56,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115165901","type":"CDM"},{"code":"00115165901","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115166001","type":"CDM"},{"code":"00115166001","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115166101","type":"CDM"},{"code":"00115166101","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00115168976","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00115168976","type":"NDC"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":8.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115351101","type":"CDM"},{"code":"00115351101","type":"NDC"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115592201","type":"CDM"},{"code":"00115592201","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115681110","type":"CDM"},{"code":"00115681110","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115703301","type":"CDM"},{"code":"00115703301","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115981101","type":"CDM"},{"code":"00115981101","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115982201","type":"CDM"},{"code":"00115982201","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116400516","type":"CDM"},{"code":"00116400516","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.52,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.41,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00121043130","type":"CDM"},{"code":"00121043130","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL ELIXIR 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121048905","type":"CDM"},{"code":"00121048905","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00121050405","type":"CDM"},{"code":"00121050405","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE SOLN 300 MG/5ML (60 MG/5ML ELEMENTAL FE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121053005","type":"CDM"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121057616","type":"CDM"},{"code":"00121057616","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121058104","type":"CDM"},{"code":"00121058104","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121058105","type":"CDM"},{"code":"00121058105","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121059515","type":"CDM"},{"code":"00121059515","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121063800","type":"CDM"},{"code":"00121063800","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121063805","type":"CDM"},{"code":"00121063805","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMANTADINE HCL SOLN 50 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121064610","type":"CDM"},{"code":"00121064610","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMANTADINE HCL SOLN 50 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121064616","type":"CDM"},{"code":"00121064616","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121067585","type":"CDM"},{"code":"00121067585","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POT & SOD CITRATES W/ CIT AC SOLN 550-500-334 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121067716","type":"CDM"},{"code":"00121067716","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121072104","type":"CDM"},{"code":"00121072104","type":"NDC"}],"standard_charges":[{"gross_charge":11.13,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.46,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) SUSP 1250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121076616","type":"CDM"},{"code":"00121076616","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121082601","type":"CDM"},{"code":"00121082601","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121083305","type":"CDM"},{"code":"00121083305","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121085320","type":"CDM"},{"code":"00121085320","type":"NDC"}],"standard_charges":[{"gross_charge":14.6,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121085416","type":"CDM"},{"code":"00121085416","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":8.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00121086720","type":"CDM"},{"code":"00121086720","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121087316","type":"CDM"},{"code":"00121087316","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00121089263","type":"CDM"},{"code":"00121089263","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121091405","type":"CDM"},{"code":"00121091405","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121094540","type":"CDM"},{"code":"00121094540","type":"NDC"}],"standard_charges":[{"gross_charge":13.85,"discounted_cash":9.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00121097251","type":"CDM"},{"code":"00121097251","type":"NDC"}],"standard_charges":[{"gross_charge":51.31,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE HCL SYRUP 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121103416","type":"CDM"},{"code":"00121103416","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121103810","type":"CDM"},{"code":"00121103810","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"discounted_cash":9.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121103840","type":"CDM"},{"code":"00121103840","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":10.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00121107255","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00121107255","type":"NDC"}],"standard_charges":[{"gross_charge":199.22,"discounted_cash":139.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115440","type":"CDM"},{"code":"00121115440","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00121146530","type":"CDM"},{"code":"00121146530","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.06,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121157610","type":"CDM"},{"code":"00121157610","type":"NDC"}],"standard_charges":[{"gross_charge":13.15,"discounted_cash":9.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121174410","type":"CDM"},{"code":"00121174410","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121176130","type":"CDM"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121185416","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"00121185416","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx00121188211","type":"CDM"},{"code":"00121188211","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx00121188294","type":"CDM"},{"code":"00121188294","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACOSAMIDE ORAL SOLUTION 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121202495","type":"CDM"},{"code":"00121202495","type":"NDC"}],"standard_charges":[{"gross_charge":56.51,"discounted_cash":39.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.11,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) SUSP 1250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121476605","type":"CDM"},{"code":"00121476605","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121477610","type":"CDM"},{"code":"00121477610","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121481005","type":"CDM"},{"code":"00121481005","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18.29,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495015","type":"CDM"},{"code":"00121495015","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121496705","type":"CDM"},{"code":"00121496705","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00131181067","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"00131181067","type":"NDC"}],"standard_charges":[{"gross_charge":1139.13,"discounted_cash":797.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":350.41,"discounted_cash":245.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":34.31,"discounted_cash":24.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACOSAMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00131247835","type":"CDM"},{"code":"00131247835","type":"NDC"}],"standard_charges":[{"gross_charge":43.9,"discounted_cash":30.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":47.13,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCERIN SUPPOS 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00132008112","type":"CDM"},{"code":"00132008112","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCERIN LIQUID SUPPOS 2.8 GM (2.7 ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00132019012","type":"CDM"},{"code":"00132019012","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.52,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00135015707","type":"CDM"},{"code":"00135015707","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00135019402","type":"CDM"},{"code":"00135019402","type":"NDC"}],"standard_charges":[{"gross_charge":3.67,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143129005","type":"CDM"},{"code":"00143129005","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143129201","type":"CDM"},{"code":"00143129201","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143129205","type":"CDM"},{"code":"00143129205","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143177201","type":"CDM"},{"code":"00143177201","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143223001","type":"CDM"},{"code":"00143223001","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143226001","type":"CDM"},{"code":"00143226001","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143909401","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"00143909401","type":"NDC"}],"standard_charges":[{"gross_charge":874.65,"discounted_cash":612.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":246.88,"discounted_cash":172.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143915610","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00143915610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143917301","type":"CDM"},{"code":"00143917301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143917310","type":"CDM"},{"code":"00143917310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSCARNET SODIUM INJ 6000 MG/250ML (24 MG/ML)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00143919201","type":"CDM"},{"code":"J1455","type":"HCPCS"},{"code":"00143919201","type":"NDC"}],"standard_charges":[{"gross_charge":1953.1,"discounted_cash":1367.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143919901","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00143919901","type":"NDC"}],"standard_charges":[{"gross_charge":160.43,"discounted_cash":112.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143920401","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00143920401","type":"NDC"}],"standard_charges":[{"gross_charge":371.7,"discounted_cash":260.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143923301","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"00143923301","type":"NDC"}],"standard_charges":[{"gross_charge":123.94,"discounted_cash":86.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143923305","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"00143923305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143925201","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00143925201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143925225","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00143925225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MITOMYCIN FOR INJ 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143927901","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"00143927901","type":"NDC"}],"standard_charges":[{"gross_charge":762.55,"discounted_cash":533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143928401","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143928401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143928410","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143928410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143929701","type":"CDM"},{"code":"00143929701","type":"NDC"}],"standard_charges":[{"gross_charge":801.83,"discounted_cash":561.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":114.08,"discounted_cash":79.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":124.17,"discounted_cash":86.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143935701","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143935701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143935710","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143935710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143935901","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143935901","type":"NDC"}],"standard_charges":[{"gross_charge":1996.13,"discounted_cash":1397.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":174.9,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938201","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"00143938201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938210","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"00143938210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143939801","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"00143939801","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":163.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143939810","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"00143939810","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":163.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143943001","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00143943001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143943010","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00143943010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":357.11,"discounted_cash":249.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143950601","type":"CDM"},{"code":"00143950601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143950610","type":"CDM"},{"code":"00143950610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143952901","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"00143952901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143953201","type":"CDM"},{"code":"00143953201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143953225","type":"CDM"},{"code":"00143953225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143955301","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00143955301","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARGATROBAN IV SOLN 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143955901","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"00143955901","type":"NDC"}],"standard_charges":[{"gross_charge":1099.75,"discounted_cash":769.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1741.3,"discounted_cash":1218.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1741.3,"discounted_cash":1218.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143956701","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143956701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143956725","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143956725","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":114.08,"discounted_cash":79.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":124.17,"discounted_cash":86.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":230.86,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00143962101","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"00143962101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00143962201","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00143962201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00143966001","type":"CDM"},{"code":"00143966001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00143966010","type":"CDM"},{"code":"00143966010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00143966801","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00143966801","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 1 MG/5ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968001","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 1 MG/5ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968025","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968025","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143968401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":230.86,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.23,"discounted_cash":103.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143971001","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143971010","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143971901","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971901","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143971910","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971910","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":156.77,"discounted_cash":109.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROGESTERONE IM IN OIL 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143972501","type":"CDM"},{"code":"J2675","type":"HCPCS"},{"code":"00143972501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GRANISETRON HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143974401","type":"CDM"},{"code":"J1626","type":"HCPCS"},{"code":"00143974401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GRANISETRON HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143974410","type":"CDM"},{"code":"J1626","type":"HCPCS"},{"code":"00143974410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143975301","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143975301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143975325","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143975325","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143975401","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143975401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143975425","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143975425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978601","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978610","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOTREXATE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143983001","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00143983001","type":"NDC"}],"standard_charges":[{"gross_charge":617.2,"discounted_cash":432.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":121.47,"discounted_cash":85.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143985324","type":"CDM"},{"code":"00143985324","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLADRIBINE IV SOLN 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143987101","type":"CDM"},{"code":"J9065","type":"HCPCS"},{"code":"00143987101","type":"NDC"}],"standard_charges":[{"gross_charge":1018.68,"discounted_cash":713.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143987201","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"00143987201","type":"NDC"}],"standard_charges":[{"gross_charge":117.56,"discounted_cash":82.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987510","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":277.21,"discounted_cash":194.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143988701","type":"CDM"},{"code":"00143988701","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143988915","type":"CDM"},{"code":"00143988915","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143989001","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00143989001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143993901","type":"CDM"},{"code":"00143993901","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143997722","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143997722","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143997790","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143997790","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR INJ 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143997922","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143997922","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR INJ 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143997990","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143997990","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00143998201","type":"CDM"},{"code":"00143998201","type":"NDC"}],"standard_charges":[{"gross_charge":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143998303","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143998303","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143998391","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143998391","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAMPHOR & MENTHOL LOTION 0.5-0.5%","drug_information":{"unit":222.0,"type":"ML"},"code_information":[{"code":"Rx00145062805","type":"CDM"},{"code":"00145062805","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":5.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":57.61,"discounted_cash":40.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000615","type":"CDM"},{"code":"00168000615","type":"NDC"}],"standard_charges":[{"gross_charge":57.7,"discounted_cash":40.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000715","type":"CDM"},{"code":"00168000715","type":"NDC"}],"standard_charges":[{"gross_charge":87.46,"discounted_cash":61.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168016215","type":"CDM"},{"code":"00168016215","type":"NDC"}],"standard_charges":[{"gross_charge":153.39,"discounted_cash":107.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168016230","type":"CDM"},{"code":"00168016230","type":"NDC"}],"standard_charges":[{"gross_charge":225.27,"discounted_cash":157.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168016315","type":"CDM"},{"code":"00168016315","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":65.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168016330","type":"CDM"},{"code":"00168016330","type":"NDC"}],"standard_charges":[{"gross_charge":137.06,"discounted_cash":95.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE SOLN 1%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00168020130","type":"CDM"},{"code":"00168020130","type":"NDC"}],"standard_charges":[{"gross_charge":96.88,"discounted_cash":67.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx00168020437","type":"CDM"},{"code":"00168020437","type":"NDC"}],"standard_charges":[{"gross_charge":661.15,"discounted_cash":462.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":71.31,"discounted_cash":49.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":249.55,"discounted_cash":174.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":151.31,"discounted_cash":105.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168082515","type":"CDM"},{"code":"00168082515","type":"NDC"}],"standard_charges":[{"gross_charge":899.41,"discounted_cash":629.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"REPAGLINIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169008181","type":"CDM"},{"code":"00169008181","type":"NDC"}],"standard_charges":[{"gross_charge":21.04,"discounted_cash":14.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN ASPART PROT & ASPART (HUMAN) INJ 100 UNIT/ML (70-30)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169368512","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169368512","type":"NDC"}],"standard_charges":[{"gross_charge":565.97,"discounted_cash":396.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HISTIDINE DILUENT IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00169701198","type":"CDM"},{"code":"00169701198","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HISTIDINE DILUENT IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00169701598","type":"CDM"},{"code":"00169701598","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 1 MG (1000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169720101","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169720101","type":"NDC"}],"standard_charges":[{"gross_charge":9831.08,"discounted_cash":6881.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML,INSULIN ASPART SOLN CARTRIDGE 100 UNIT/ML,INSULIN ASPART SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169750111","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00169750111","type":"NDC"}],"standard_charges":[{"gross_charge":565.97,"discounted_cash":396.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML,INSULIN ASPART SOLN CARTRIDGE 100 UNIT/ML,INSULIN ASPART SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169750111","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169750111","type":"NDC"}],"standard_charges":[{"gross_charge":565.97,"discounted_cash":396.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETRACYCLINE HCL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172241610","type":"CDM"},{"code":"00172241610","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172409660","type":"CDM"},{"code":"00172409660","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172436400","type":"CDM"},{"code":"00172436400","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541000","type":"CDM"},{"code":"00172541000","type":"NDC"}],"standard_charges":[{"gross_charge":20.05,"discounted_cash":14.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541100","type":"CDM"},{"code":"00172541100","type":"NDC"}],"standard_charges":[{"gross_charge":26.48,"discounted_cash":18.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541160","type":"CDM"},{"code":"00172541160","type":"NDC"}],"standard_charges":[{"gross_charge":13.19,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541360","type":"CDM"},{"code":"00172541360","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172572860","type":"CDM"},{"code":"00172572860","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00172731320","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00172731320","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173024256","type":"CDM"},{"code":"00173024256","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCINE DILUENT FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00173051801","type":"CDM"},{"code":"00173051801","type":"NDC"}],"standard_charges":[{"gross_charge":256.78,"discounted_cash":179.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SALMETEROL XINAFOATE AER POW BA 50 MCG/ACT (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173052000","type":"CDM"},{"code":"00173052000","type":"NDC"}],"standard_charges":[{"gross_charge":73.39,"discounted_cash":51.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SALMETEROL XINAFOATE AER POW BA 50 MCG/ACT (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173052100","type":"CDM"},{"code":"00173052100","type":"NDC"}],"standard_charges":[{"gross_charge":69.12,"discounted_cash":48.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173052700","type":"CDM"},{"code":"00173052700","type":"NDC"}],"standard_charges":[{"gross_charge":34.74,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00173054700","type":"CDM"},{"code":"00173054700","type":"NDC"}],"standard_charges":[{"gross_charge":66.39,"discounted_cash":46.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":18.0,"type":"GM"},"code_information":[{"code":"Rx00173068220","type":"CDM"},{"code":"00173068220","type":"NDC"}],"standard_charges":[{"gross_charge":201.03,"discounted_cash":140.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":109.88,"discounted_cash":76.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24.42,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUTICASONE PROPIONATE HFA INHAL AERO 44 MCG/ACT","drug_information":{"unit":10.6,"type":"GM"},"code_information":[{"code":"Rx00173071820","type":"CDM"},{"code":"00173071820","type":"NDC"}],"standard_charges":[{"gross_charge":538.17,"discounted_cash":376.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173082318","type":"CDM"},{"code":"00173082318","type":"NDC"}],"standard_charges":[{"gross_charge":30.78,"discounted_cash":21.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"UMECLIDINIUM-VILANTEROL AERO POWD BA 62.5-25 MCG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173086906","type":"CDM"},{"code":"00173086906","type":"NDC"}],"standard_charges":[{"gross_charge":63.1,"discounted_cash":44.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13163.42,"discounted_cash":9214.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":47401.67,"discounted_cash":33181.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM IODIDE (ANTIDOTE) ORAL SOLN 65 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00178031430","type":"CDM"},{"code":"00178031430","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185011705","type":"CDM"},{"code":"00185011705","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185014501","type":"CDM"},{"code":"00185014501","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185022360","type":"CDM"},{"code":"00185022360","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185067401","type":"CDM"},{"code":"00185067401","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185067405","type":"CDM"},{"code":"00185067405","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185084201","type":"CDM"},{"code":"00185084201","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPLERENONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185536830","type":"CDM"},{"code":"00185536830","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 0.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00186013501","type":"CDM"},{"code":"00186013501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":211.59,"discounted_cash":148.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT","drug_information":{"unit":10.2,"type":"GM"},"code_information":[{"code":"Rx00186037220","type":"CDM"},{"code":"00186037220","type":"NDC"}],"standard_charges":[{"gross_charge":591.74,"discounted_cash":414.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":211.59,"discounted_cash":148.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TICAGRELOR TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077660","type":"CDM"},{"code":"00186077660","type":"NDC"}],"standard_charges":[{"gross_charge":23.33,"discounted_cash":16.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":23.33,"discounted_cash":16.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077760","type":"CDM"},{"code":"00186077760","type":"NDC"}],"standard_charges":[{"gross_charge":23.33,"discounted_cash":16.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186109039","type":"CDM"},{"code":"00186109039","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":404.18,"discounted_cash":282.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EMOLLIENT - LOTION","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00187137127","type":"CDM"},{"code":"00187137127","type":"NDC"}],"standard_charges":[{"gross_charge":9.24,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187301330","type":"CDM"},{"code":"00187301330","type":"NDC"}],"standard_charges":[{"gross_charge":87.39,"discounted_cash":61.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOBARBITAL SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187430305","type":"CDM"},{"code":"J0300","type":"HCPCS"},{"code":"00187430305","type":"NDC"}],"standard_charges":[{"gross_charge":2661.35,"discounted_cash":1862.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00206885508","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885508","type":"NDC"}],"standard_charges":[{"gross_charge":480.33,"discounted_cash":336.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TROLAMINE SALICYLATE CREAM 10%","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx00225036011","type":"CDM"},{"code":"00225036011","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 0.25%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00225080047","type":"CDM"},{"code":"00225080047","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4.39,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228202910","type":"CDM"},{"code":"00228202910","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228207610","type":"CDM"},{"code":"00228207610","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228212750","type":"CDM"},{"code":"00228212750","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPYLTHIOURACIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228234810","type":"CDM"},{"code":"00228234810","type":"NDC"}],"standard_charges":[{"gross_charge":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228249710","type":"CDM"},{"code":"00228249710","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228282011","type":"CDM"},{"code":"00228282011","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228287811","type":"CDM"},{"code":"00228287811","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228305911","type":"CDM"},{"code":"00228305911","type":"NDC"}],"standard_charges":[{"gross_charge":13.64,"discounted_cash":9.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB ER 24HR 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228365803","type":"CDM"},{"code":"00228365803","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"discounted_cash":9.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001389","type":"CDM"},{"code":"00245001389","type":"NDC"}],"standard_charges":[{"gross_charge":12.45,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTIC ACID (AMMONIUM LACTATE) LOTION 12%","drug_information":{"unit":225.0,"type":"GM"},"code_information":[{"code":"Rx00245002322","type":"CDM"},{"code":"00245002322","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CITRATE TAB ER 10 MEQ (1080 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245007111","type":"CDM"},{"code":"00245007111","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.67,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014789","type":"CDM"},{"code":"00245014789","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.32,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245036001","type":"CDM"},{"code":"00245036001","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245036030","type":"CDM"},{"code":"00245036030","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245036089","type":"CDM"},{"code":"00245036089","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.85,"discounted_cash":102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIODARONE HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245164501","type":"CDM"},{"code":"00245164501","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531990","type":"CDM"},{"code":"00245531990","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00254200801","type":"CDM"},{"code":"00254200801","type":"NDC"}],"standard_charges":[{"gross_charge":19.81,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POSACONAZOLE TAB DELAYED RELEASE 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00254204502","type":"CDM"},{"code":"00254204502","type":"NDC"}],"standard_charges":[{"gross_charge":37.83,"discounted_cash":26.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LUBIPROSTONE CAP 24 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00254302902","type":"CDM"},{"code":"00254302902","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE ORAL SOLN 1 MG/5ML","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00259050116","type":"CDM"},{"code":"00259050116","type":"NDC"}],"standard_charges":[{"gross_charge":866.32,"discounted_cash":606.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264194020","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00264194020","type":"NDC"}],"standard_charges":[{"gross_charge":302.1,"discounted_cash":211.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx00264220170","type":"CDM"},{"code":"00264220170","type":"NDC"}],"standard_charges":[{"gross_charge":167.98,"discounted_cash":117.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACID INFUSION 15%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264320055","type":"CDM"},{"code":"00264320055","type":"NDC"}],"standard_charges":[{"gross_charge":200.74,"discounted_cash":140.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACID INFUSION 15%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264450000","type":"CDM"},{"code":"00264450000","type":"NDC"}],"standard_charges":[{"gross_charge":229.99,"discounted_cash":160.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264500990","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00264500990","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264553532","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00264553532","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 70%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00264738750","type":"CDM"},{"code":"00264738750","type":"NDC"}],"standard_charges":[{"gross_charge":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264751010","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264751010","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264752020","type":"CDM"},{"code":"00264752020","type":"NDC"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264757810","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00264757810","type":"NDC"}],"standard_charges":[{"gross_charge":178.31,"discounted_cash":124.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264761200","type":"CDM"},{"code":"00264761200","type":"NDC"}],"standard_charges":[{"gross_charge":151.99,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264775010","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00264775010","type":"NDC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264780000","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00264780000","type":"NDC"}],"standard_charges":[{"gross_charge":145.65,"discounted_cash":101.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":149.55,"discounted_cash":104.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264780510","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00264780510","type":"NDC"}],"standard_charges":[{"gross_charge":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264785020","type":"CDM"},{"code":"00264785020","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE)-DEXTROSE IV SOL 25000 UNIT/500ML-5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264957710","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00264957710","type":"NDC"}],"standard_charges":[{"gross_charge":173.44,"discounted_cash":121.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264959420","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00264959420","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":158.81,"discounted_cash":111.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00264987210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00264987210","type":"NDC"}],"standard_charges":[{"gross_charge":151.99,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00270055615","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"00270055615","type":"NDC"}],"standard_charges":[{"gross_charge":1577.64,"discounted_cash":1104.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 76%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00270131601","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131601","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 76%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00270131637","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131637","type":"NDC"}],"standard_charges":[{"gross_charge":160.65,"discounted_cash":112.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH 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: WSH LOCATION"}]},{"description":"GADOBENATE DIMEGLUMINE IV SOLN 529 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00270516413","type":"CDM"},{"code":"A9577","type":"HCPCS"},{"code":"00270516413","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00281032608","type":"CDM"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9.66,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9.66,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZOCAINE DENTAL GEL 20%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00283087131","type":"CDM"},{"code":"00283087131","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZOCAINE DENTAL GEL 20%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00283101631","type":"CDM"},{"code":"00283101631","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EMOLLIENT - LOTION","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00299024132","type":"CDM"},{"code":"00299024132","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EMOLLIENT - LOTION","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00299391808","type":"CDM"},{"code":"00299391808","type":"NDC"}],"standard_charges":[{"gross_charge":7.34,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310027239","type":"CDM"},{"code":"00310027239","type":"NDC"}],"standard_charges":[{"gross_charge":32.15,"discounted_cash":22.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310027439","type":"CDM"},{"code":"00310027439","type":"NDC"}],"standard_charges":[{"gross_charge":39.01,"discounted_cash":27.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310027939","type":"CDM"},{"code":"00310027939","type":"NDC"}],"standard_charges":[{"gross_charge":44.07,"discounted_cash":30.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB ER 24HR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310028439","type":"CDM"},{"code":"00310028439","type":"NDC"}],"standard_charges":[{"gross_charge":50.08,"discounted_cash":35.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB ER 24HR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310028460","type":"CDM"},{"code":"00310028460","type":"NDC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310075190","type":"CDM"},{"code":"00310075190","type":"NDC"}],"standard_charges":[{"gross_charge":25.72,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310075290","type":"CDM"},{"code":"00310075290","type":"NDC"}],"standard_charges":[{"gross_charge":26.04,"discounted_cash":18.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":21006.98,"discounted_cash":14704.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22086.83,"discounted_cash":15460.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4061.25,"discounted_cash":2842.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16921.83,"discounted_cash":11845.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT","drug_information":{"unit":10.2,"type":"GM"},"code_information":[{"code":"Rx00310737220","type":"CDM"},{"code":"00310737220","type":"NDC"}],"standard_charges":[{"gross_charge":601.61,"discounted_cash":421.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx00316022530","type":"CDM"},{"code":"00316022530","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAMPHOR & MENTHOL LOTION 0.5-0.5%","drug_information":{"unit":222.0,"type":"ML"},"code_information":[{"code":"Rx00316022975","type":"CDM"},{"code":"00316022975","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":155.07,"discounted_cash":108.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338000344","type":"CDM"},{"code":"00338000344","type":"NDC"}],"standard_charges":[{"gross_charge":151.99,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00338000347","type":"CDM"},{"code":"00338000347","type":"NDC"}],"standard_charges":[{"gross_charge":161.74,"discounted_cash":113.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338000404","type":"CDM"},{"code":"00338000404","type":"NDC"}],"standard_charges":[{"gross_charge":151.99,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.62,"discounted_cash":102.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338001741","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":147.01,"discounted_cash":102.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.57,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.67,"discounted_cash":104.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":162.11,"discounted_cash":113.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.62,"discounted_cash":102.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":145.65,"discounted_cash":101.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":161.74,"discounted_cash":113.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00338004729","type":"CDM"},{"code":"00338004729","type":"NDC"}],"standard_charges":[{"gross_charge":184.65,"discounted_cash":129.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":1500.0,"type":"ML"},"code_information":[{"code":"Rx00338004805","type":"CDM"},{"code":"00338004805","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.62,"discounted_cash":102.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004911","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004911","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.92,"discounted_cash":102.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004918","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004918","type":"NDC"}],"standard_charges":[{"gross_charge":151.01,"discounted_cash":105.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.92,"discounted_cash":102.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338004941","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004941","type":"NDC"}],"standard_charges":[{"gross_charge":146.82,"discounted_cash":102.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004941","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004941","type":"NDC"}],"standard_charges":[{"gross_charge":157.35,"discounted_cash":110.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004948","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004948","type":"NDC"}],"standard_charges":[{"gross_charge":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004948","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004948","type":"NDC"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1500.03,"discounted_cash":1050.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338008502","type":"CDM"},{"code":"00338008502","type":"NDC"}],"standard_charges":[{"gross_charge":163.69,"discounted_cash":114.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338008903","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00338008903","type":"NDC"}],"standard_charges":[{"gross_charge":163.69,"discounted_cash":114.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.14,"discounted_cash":102.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION,ELECTROLYTE-A SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338022104","type":"CDM"},{"code":"00338022104","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":645.69,"discounted_cash":451.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00338035703","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00338035703","type":"NDC"}],"standard_charges":[{"gross_charge":151.01,"discounted_cash":105.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 4 MG/ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338040903","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00338040903","type":"NDC"}],"standard_charges":[{"gross_charge":151.99,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":151.5,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":280.69,"discounted_cash":196.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1.2 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338050741","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050741","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1.2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338050748","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050748","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1.6 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338050941","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050941","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 2 MG/ML","drug_information":{"unit":80.0,"type":"ML"},"code_information":[{"code":"Rx00338051141","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338051141","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338051909","type":"CDM"},{"code":"00338051909","type":"NDC"}],"standard_charges":[{"gross_charge":243.02,"discounted_cash":170.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338051913","type":"CDM"},{"code":"00338051913","type":"NDC"}],"standard_charges":[{"gross_charge":293.17,"discounted_cash":205.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338051958","type":"CDM"},{"code":"00338051958","type":"NDC"}],"standard_charges":[{"gross_charge":185.16,"discounted_cash":129.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338051958","type":"CDM"},{"code":"00338051958","type":"NDC"}],"standard_charges":[{"gross_charge":555.48,"discounted_cash":388.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":149.55,"discounted_cash":104.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":149.45,"discounted_cash":104.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338055318","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"gross_charge":159.98,"discounted_cash":111.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338064404","type":"CDM"},{"code":"00338064404","type":"NDC"}],"standard_charges":[{"gross_charge":185.14,"discounted_cash":129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338064406","type":"CDM"},{"code":"00338064406","type":"NDC"}],"standard_charges":[{"gross_charge":222.19,"discounted_cash":155.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.2% INJ,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.225% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338066304","type":"CDM"},{"code":"00338066304","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338067103","type":"CDM"},{"code":"00338067103","type":"NDC"}],"standard_charges":[{"gross_charge":173.8,"discounted_cash":121.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338067304","type":"CDM"},{"code":"00338067304","type":"NDC"}],"standard_charges":[{"gross_charge":168.33,"discounted_cash":117.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN DEXTROSE 5% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338068304","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338068304","type":"NDC"}],"standard_charges":[{"gross_charge":167.59,"discounted_cash":117.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338070341","type":"CDM"},{"code":"00338070341","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 40 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338070348","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070348","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":151.99,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 70%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338071906","type":"CDM"},{"code":"00338071906","type":"NDC"}],"standard_charges":[{"gross_charge":171.49,"discounted_cash":120.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":186.82,"discounted_cash":130.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":254.59,"discounted_cash":178.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338113004","type":"CDM"},{"code":"00338113004","type":"NDC"}],"standard_charges":[{"gross_charge":233.89,"discounted_cash":163.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 300 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338341050","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338341050","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338361624","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338361624","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338601048","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00338601048","type":"NDC"}],"standard_charges":[{"gross_charge":178.98,"discounted_cash":125.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 40 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00338601137","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00338601137","type":"NDC"}],"standard_charges":[{"gross_charge":367.23,"discounted_cash":257.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00338604537","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00338604537","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338954001","type":"CDM"},{"code":"00338954001","type":"NDC"}],"standard_charges":[{"gross_charge":456.72,"discounted_cash":319.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954001","type":"CDM"},{"code":"00338954001","type":"NDC"}],"standard_charges":[{"gross_charge":1141.82,"discounted_cash":799.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":204.44,"discounted_cash":143.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338954003","type":"CDM"},{"code":"00338954003","type":"NDC"}],"standard_charges":[{"gross_charge":609.48,"discounted_cash":426.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":304.74,"discounted_cash":213.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954005","type":"CDM"},{"code":"00338954005","type":"NDC"}],"standard_charges":[{"gross_charge":424.32,"discounted_cash":297.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338954005","type":"CDM"},{"code":"00338954005","type":"NDC"}],"standard_charges":[{"gross_charge":169.73,"discounted_cash":118.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":216.02,"discounted_cash":151.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338954007","type":"CDM"},{"code":"00338954007","type":"NDC"}],"standard_charges":[{"gross_charge":262.31,"discounted_cash":183.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338954304","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338954304","type":"NDC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":253.05,"discounted_cash":177.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 4 MG/ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338958624","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00338958624","type":"NDC"}],"standard_charges":[{"gross_charge":151.01,"discounted_cash":105.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338959030","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00338959030","type":"NDC"}],"standard_charges":[{"gross_charge":156.86,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378001801","type":"CDM"},{"code":"00378001801","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLORAZEPATE DIPOTASSIUM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378004005","type":"CDM"},{"code":"00378004005","type":"NDC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":8.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378004501","type":"CDM"},{"code":"00378004501","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378014491","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00378014491","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROBENECID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378015601","type":"CDM"},{"code":"00378015601","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378018301","type":"CDM"},{"code":"00378018301","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378041501","type":"CDM"},{"code":"00378041501","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378061401","type":"CDM"},{"code":"00378061401","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378082501","type":"CDM"},{"code":"00378082501","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40.33,"discounted_cash":28.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":55.55,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":61.1,"discounted_cash":42.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":86.61,"discounted_cash":60.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.3 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087316","type":"CDM"},{"code":"00378087316","type":"NDC"}],"standard_charges":[{"gross_charge":116.2,"discounted_cash":81.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.3 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087399","type":"CDM"},{"code":"00378087399","type":"NDC"}],"standard_charges":[{"gross_charge":116.23,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378114001","type":"CDM"},{"code":"00378114001","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378116580","type":"CDM"},{"code":"00378116580","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378130001","type":"CDM"},{"code":"00378130001","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180001","type":"CDM"},{"code":"00378180001","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378181701","type":"CDM"},{"code":"00378181701","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378182301","type":"CDM"},{"code":"00378182301","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 137 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378182377","type":"CDM"},{"code":"00378182377","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BROMOCRIPTINE MESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378204293","type":"CDM"},{"code":"00378204293","type":"NDC"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378207193","type":"CDM"},{"code":"00378207193","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAPECITABINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378251278","type":"CDM"},{"code":"J8522","type":"HCPCS"},{"code":"00378251278","type":"NDC"}],"standard_charges":[{"gross_charge":24.22,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378302001","type":"CDM"},{"code":"00378302001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"REPAGLINIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378312101","type":"CDM"},{"code":"00378312101","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":10.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378335299","type":"CDM"},{"code":"00378335299","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":29.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378385777","type":"CDM"},{"code":"00378385777","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378395277","type":"CDM"},{"code":"00378395277","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378395377","type":"CDM"},{"code":"00378395377","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378402101","type":"CDM"},{"code":"00378402101","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378402201","type":"CDM"},{"code":"00378402201","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378402401","type":"CDM"},{"code":"00378402401","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378410591","type":"CDM"},{"code":"00378410591","type":"NDC"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378427593","type":"CDM"},{"code":"00378427593","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378459577","type":"CDM"},{"code":"00378459577","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378459777","type":"CDM"},{"code":"00378459777","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378501101","type":"CDM"},{"code":"00378501101","type":"NDC"}],"standard_charges":[{"gross_charge":12.01,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378551293","type":"CDM"},{"code":"00378551293","type":"NDC"}],"standard_charges":[{"gross_charge":13.29,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378551393","type":"CDM"},{"code":"00378551393","type":"NDC"}],"standard_charges":[{"gross_charge":14.47,"discounted_cash":10.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378563159","type":"CDM"},{"code":"00378563159","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378580793","type":"CDM"},{"code":"00378580793","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378581377","type":"CDM"},{"code":"00378581377","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378604328","type":"CDM"},{"code":"00378604328","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378606001","type":"CDM"},{"code":"00378606001","type":"NDC"}],"standard_charges":[{"gross_charge":14.47,"discounted_cash":10.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378616001","type":"CDM"},{"code":"00378616001","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE FOR SUSP 40 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00378627045","type":"CDM"},{"code":"00378627045","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378628001","type":"CDM"},{"code":"00378628001","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACAMPROSATE CALCIUM TAB DELAYED RELEASE 333 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378633380","type":"CDM"},{"code":"00378633380","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378660501","type":"CDM"},{"code":"00378660501","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZONISAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378672501","type":"CDM"},{"code":"00378672501","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.2,"type":"EA"},"code_information":[{"code":"Rx00378699331","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"00378699331","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":30.0,"type":"EA"},"code_information":[{"code":"Rx00378699393","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"00378699393","type":"NDC"}],"standard_charges":[{"gross_charge":270.87,"discounted_cash":189.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378700193","type":"CDM"},{"code":"00378700193","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378710077","type":"CDM"},{"code":"00378710077","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378773293","type":"CDM"},{"code":"00378773293","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUVASTATIN SODIUM CAP 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378802093","type":"CDM"},{"code":"00378802093","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00378870006","type":"CDM"},{"code":"00378870006","type":"NDC"}],"standard_charges":[{"gross_charge":248.51,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876058","type":"CDM"},{"code":"00378876058","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":11.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876091","type":"CDM"},{"code":"00378876091","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378905593","type":"CDM"},{"code":"00378905593","type":"NDC"}],"standard_charges":[{"gross_charge":24.21,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.1 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910293","type":"CDM"},{"code":"00378910293","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910493","type":"CDM"},{"code":"00378910493","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":41.25,"discounted_cash":28.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":41.25,"discounted_cash":28.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":23.89,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":46.23,"discounted_cash":32.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ORAL VEHICLES - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395009416","type":"CDM"},{"code":"00395009416","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALAMINE-ZINC OXIDE LOTION","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx00395041396","type":"CDM"},{"code":"00395041396","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCERIN LIQUID","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395103116","type":"CDM"},{"code":"00395103116","type":"NDC"}],"standard_charges":[{"gross_charge":23.65,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHERRY SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395266216","type":"CDM"},{"code":"00395266216","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.95,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.58,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012501","type":"CDM"},{"code":"00406012501","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012523","type":"CDM"},{"code":"00406012523","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.75,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406036501","type":"CDM"},{"code":"00406036501","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406036523","type":"CDM"},{"code":"00406036523","type":"NDC"}],"standard_charges":[{"gross_charge":12.04,"discounted_cash":8.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406036562","type":"CDM"},{"code":"00406036562","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406036662","type":"CDM"},{"code":"00406036662","type":"NDC"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.19,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.6,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051201","type":"CDM"},{"code":"00406051201","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.22,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.4,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00406052710","type":"CDM"},{"code":"00406052710","type":"NDC"}],"standard_charges":[{"gross_charge":134.96,"discounted_cash":94.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.37,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.88,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406114401","type":"CDM"},{"code":"00406114401","type":"NDC"}],"standard_charges":[{"gross_charge":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406123601","type":"CDM"},{"code":"00406123601","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.86,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406575523","type":"CDM"},{"code":"00406575523","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406575562","type":"CDM"},{"code":"00406575562","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.14,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.68,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.23,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406833023","type":"CDM"},{"code":"00406833023","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406833062","type":"CDM"},{"code":"00406833062","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406839062","type":"CDM"},{"code":"00406839062","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406851501","type":"CDM"},{"code":"00406851501","type":"NDC"}],"standard_charges":[{"gross_charge":12.09,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROAMPHETAMINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406895801","type":"CDM"},{"code":"00406895801","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMAZEPAM CAP 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406996001","type":"CDM"},{"code":"00406996001","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141208","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141208","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141343","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141343","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141444","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141444","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141445","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141445","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141491","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141491","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 270 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222202","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222202","type":"NDC"}],"standard_charges":[{"gross_charge":105.9,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 270 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222216","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222216","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 270 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222217","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222217","type":"NDC"}],"standard_charges":[{"gross_charge":96.3,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 270 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00407222219","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222219","type":"NDC"}],"standard_charges":[{"gross_charge":154.35,"discounted_cash":108.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222301","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222301","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222302","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222302","type":"NDC"}],"standard_charges":[{"gross_charge":197.7,"discounted_cash":138.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222306","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222306","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222316","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222316","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222317","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222317","type":"NDC"}],"standard_charges":[{"gross_charge":96.3,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00407222323","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222323","type":"NDC"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":434.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222362","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222362","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222363","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222363","type":"NDC"}],"standard_charges":[{"gross_charge":148.2,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222364","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222364","type":"NDC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00407222365","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222365","type":"NDC"}],"standard_charges":[{"gross_charge":204.75,"discounted_cash":143.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00407222366","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222366","type":"NDC"}],"standard_charges":[{"gross_charge":142.65,"discounted_cash":99.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00407222367","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222367","type":"NDC"}],"standard_charges":[{"gross_charge":259.8,"discounted_cash":181.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409012501","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409012501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409012525","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409012525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":411.49,"discounted_cash":288.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409021202","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00409021202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409021211","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00409021211","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPOTECAN HCL INJ 4 MG/4ML (BASE EQUIV) (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409030201","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"00409030201","type":"NDC"}],"standard_charges":[{"gross_charge":1591.97,"discounted_cash":1114.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409036701","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00409036701","type":"NDC"}],"standard_charges":[{"gross_charge":1013.36,"discounted_cash":709.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409083001","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00409083001","type":"NDC"}],"standard_charges":[{"gross_charge":735.78,"discounted_cash":515.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409083011","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00409083011","type":"NDC"}],"standard_charges":[{"gross_charge":719.8,"discounted_cash":503.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409113405","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409113405","type":"NDC"}],"standard_charges":[{"gross_charge":420.46,"discounted_cash":294.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409114102","type":"CDM"},{"code":"00409114102","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409114405","type":"CDM"},{"code":"00409114405","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115909","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115909","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116001","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116201","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116218","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116218","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116301","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409117630","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409117630","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409117830","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409117830","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120725","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120725","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409121501","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409121501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409121901","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409121901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409125830","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409125830","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":168.35,"discounted_cash":117.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409127632","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409127632","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409131203","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409131203","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409131230","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409131230","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409131901","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409131901","type":"NDC"}],"standard_charges":[{"gross_charge":2574.75,"discounted_cash":1802.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146349","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146349","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409146369","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146369","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146401","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409146461","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146461","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALBUPHINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146501","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409158750","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409158750","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162601","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162601","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":183.96,"discounted_cash":128.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409163802","type":"CDM"},{"code":"00409163802","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174670","type":"CDM"},{"code":"00409174670","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409175250","type":"CDM"},{"code":"00409175250","type":"NDC"}],"standard_charges":[{"gross_charge":235.32,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409175415","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409175415","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409176102","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409176102","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409176119","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409176119","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409178269","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409178269","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189001","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189003","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189003","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189013","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189013","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189023","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189023","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1522.41,"discounted_cash":1065.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409204501","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00409204501","type":"NDC"}],"standard_charges":[{"gross_charge":228.36,"discounted_cash":159.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409205310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205310","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409206605","type":"CDM"},{"code":"00409206605","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409206610","type":"CDM"},{"code":"00409206610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409222001","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00409222001","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409233610","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"00409233610","type":"NDC"}],"standard_charges":[{"gross_charge":129.82,"discounted_cash":90.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234401","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234401","type":"NDC"}],"standard_charges":[{"gross_charge":110.02,"discounted_cash":77.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234402","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234402","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234462","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234462","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234488","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234488","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 2 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234731","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234731","type":"NDC"}],"standard_charges":[{"gross_charge":150.44,"discounted_cash":105.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 2 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234732","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234732","type":"NDC"}],"standard_charges":[{"gross_charge":551.62,"discounted_cash":386.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409259605","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409259605","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":210.31,"discounted_cash":147.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML CRRT INFUSION,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409272002","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"},{"gross_charge":150.07,"discounted_cash":105.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML CRRT INFUSION,HEPARIN SODIUM (PORCINE) PF 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409272003","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272003","type":"NDC"}],"standard_charges":[{"gross_charge":110.66,"discounted_cash":77.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409272030","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272030","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409272101","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409272130","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272130","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409298723","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00409298723","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317801","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317802","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317802","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317816","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317816","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317817","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317817","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409318301","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409329451","type":"CDM"},{"code":"00409329451","type":"NDC"}],"standard_charges":[{"gross_charge":162.97,"discounted_cash":114.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409329906","type":"CDM"},{"code":"00409329906","type":"NDC"}],"standard_charges":[{"gross_charge":128.79,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409330803","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00409330803","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409330811","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00409330811","type":"NDC"}],"standard_charges":[{"gross_charge":12.88,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409333001","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00409333001","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409337402","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00409337402","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409337504","type":"CDM"},{"code":"00409337504","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409337813","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00409337813","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409337904","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00409337904","type":"NDC"}],"standard_charges":[{"gross_charge":121.76,"discounted_cash":85.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 50 MCG/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00409338221","type":"CDM"},{"code":"00409338221","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409338302","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00409338302","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409338513","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00409338513","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409351501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409351501","type":"NDC"}],"standard_charges":[{"gross_charge":180.94,"discounted_cash":126.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409351511","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409351511","type":"NDC"}],"standard_charges":[{"gross_charge":202.43,"discounted_cash":141.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409361301","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409361301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409379319","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379319","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00409379501","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409381511","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409381511","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409381512","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409381512","type":"NDC"}],"standard_charges":[{"gross_charge":282.06,"discounted_cash":197.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409401101","type":"CDM"},{"code":"00409401101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MANNITOL IV SOLN 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409403101","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00409403101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MANNITOL IV SOLN 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409403116","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00409403116","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZINC CHLORIDE INJ 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409001","type":"CDM"},{"code":"00409409001","type":"NDC"}],"standard_charges":[{"gross_charge":339.3,"discounted_cash":237.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":453.15,"discounted_cash":317.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHROMIC CHLORIDE INJ 40 MCG/10ML (4 MCG/ML) (ELEMENTAL CR)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409310","type":"CDM"},{"code":"00409409310","type":"NDC"}],"standard_charges":[{"gross_charge":289.22,"discounted_cash":202.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409419701","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00409419701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 0.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427501","type":"CDM"},{"code":"00409427501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 0.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427516","type":"CDM"},{"code":"00409427516","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427602","type":"CDM"},{"code":"00409427602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427617","type":"CDM"},{"code":"00409427617","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427701","type":"CDM"},{"code":"00409427701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427702","type":"CDM"},{"code":"00409427702","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427716","type":"CDM"},{"code":"00409427716","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427717","type":"CDM"},{"code":"00409427717","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":114.87,"discounted_cash":80.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409434609","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00409434609","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409434610","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00409434610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409434616","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00409434616","type":"NDC"}],"standard_charges":[{"gross_charge":103.35,"discounted_cash":72.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409434673","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00409434673","type":"NDC"}],"standard_charges":[{"gross_charge":103.35,"discounted_cash":72.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL IV FOR SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409435003","type":"CDM"},{"code":"00409435003","type":"NDC"}],"standard_charges":[{"gross_charge":127.99,"discounted_cash":89.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL IV FOR SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409435013","type":"CDM"},{"code":"00409435013","type":"NDC"}],"standard_charges":[{"gross_charge":129.39,"discounted_cash":90.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409469930","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469930","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409469950","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469950","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409469953","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469953","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409469954","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469954","type":"NDC"}],"standard_charges":[{"gross_charge":143.1,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409475901","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00409475901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN 200 MG/100ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477723","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477723","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409488799","type":"CDM"},{"code":"00409488799","type":"NDC"}],"standard_charges":[{"gross_charge":103.35,"discounted_cash":72.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488812","type":"CDM"},{"code":"00409488812","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490024","type":"CDM"},{"code":"00409490024","type":"NDC"}],"standard_charges":[{"gross_charge":457.92,"discounted_cash":320.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490234","type":"CDM"},{"code":"00409490234","type":"NDC"}],"standard_charges":[{"gross_charge":159.54,"discounted_cash":111.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490264","type":"CDM"},{"code":"00409490264","type":"NDC"}],"standard_charges":[{"gross_charge":155.79,"discounted_cash":109.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.5,"type":"ML"},"code_information":[{"code":"Rx00409490334","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409490334","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409491111","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409491111","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409491134","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409491134","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409492811","type":"CDM"},{"code":"00409492811","type":"NDC"}],"standard_charges":[{"gross_charge":128.15,"discounted_cash":89.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409492834","type":"CDM"},{"code":"00409492834","type":"NDC"}],"standard_charges":[{"gross_charge":248.51,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508211","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508211","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508216","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508216","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508411","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508411","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508413","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508413","type":"NDC"}],"standard_charges":[{"gross_charge":135.24,"discounted_cash":94.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 6 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508611","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508611","type":"NDC"}],"standard_charges":[{"gross_charge":445.51,"discounted_cash":311.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":288.74,"discounted_cash":202.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":262.35,"discounted_cash":183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409582001","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409582001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":286.04,"discounted_cash":200.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":178.55,"discounted_cash":124.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":184.12,"discounted_cash":128.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409592216","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592216","type":"NDC"}],"standard_charges":[{"gross_charge":110.98,"discounted_cash":77.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610202","type":"CDM"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":55.87,"discounted_cash":39.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610210","type":"CDM"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":51.99,"discounted_cash":36.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610210","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610218","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610218","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610219","type":"CDM"},{"code":"00409610219","type":"NDC"}],"standard_charges":[{"gross_charge":51.39,"discounted_cash":35.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610220","type":"CDM"},{"code":"00409610220","type":"NDC"}],"standard_charges":[{"gross_charge":51.91,"discounted_cash":36.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610220","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610220","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610227","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610227","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409613803","type":"CDM"},{"code":"00409613803","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409613822","type":"CDM"},{"code":"00409613822","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409651001","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409651001","type":"NDC"}],"standard_charges":[{"gross_charge":414.19,"discounted_cash":289.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653102","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653102","type":"NDC"}],"standard_charges":[{"gross_charge":140.9,"discounted_cash":98.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653112","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653112","type":"NDC"}],"standard_charges":[{"gross_charge":108.86,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":233.47,"discounted_cash":163.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409662902","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00409662902","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":127.2,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.06,"discounted_cash":107.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":152.28,"discounted_cash":106.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409665106","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409665106","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409665119","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409665119","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409665305","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409665305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409665318","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409665318","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409665773","type":"CDM"},{"code":"00409665773","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00409666075","type":"CDM"},{"code":"00409666075","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409669501","type":"CDM"},{"code":"00409669501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409669511","type":"CDM"},{"code":"00409669511","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409672723","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409672923","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672923","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409672924","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672924","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/50ML (80 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409673013","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409673013","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409677802","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409677802","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409707426","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409707426","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409710102","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710102","type":"NDC"}],"standard_charges":[{"gross_charge":150.52,"discounted_cash":105.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINO ACID INFUSION 15%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00409717117","type":"CDM"},{"code":"00409717117","type":"NDC"}],"standard_charges":[{"gross_charge":226.09,"discounted_cash":158.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HETASTARCH (HES /0.7 OR /0.75) 6% IN NACL 0.9% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409724813","type":"CDM"},{"code":"00409724813","type":"NDC"}],"standard_charges":[{"gross_charge":156.86,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409729501","type":"CDM"},{"code":"00409729501","type":"NDC"}],"standard_charges":[{"gross_charge":169.09,"discounted_cash":118.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409729511","type":"CDM"},{"code":"00409729511","type":"NDC"}],"standard_charges":[{"gross_charge":202.48,"discounted_cash":141.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":163.13,"discounted_cash":114.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733410","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733410","type":"NDC"}],"standard_charges":[{"gross_charge":241.2,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733701","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733711","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733711","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733801","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733811","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733811","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":586.23,"discounted_cash":410.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":266.4,"discounted_cash":186.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTRAN 40 INJ 10% IN SALINE","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409741903","type":"CDM"},{"code":"J7100","type":"HCPCS"},{"code":"00409741903","type":"NDC"}],"standard_charges":[{"gross_charge":282.64,"discounted_cash":197.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":177.34,"discounted_cash":124.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":159.01,"discounted_cash":111.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":151.01,"discounted_cash":105.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":162.71,"discounted_cash":113.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":162.71,"discounted_cash":113.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409771503","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00409771503","type":"NDC"}],"standard_charges":[{"gross_charge":175.39,"discounted_cash":122.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00409771513","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00409771513","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409773036","type":"CDM"},{"code":"00409773036","type":"NDC"}],"standard_charges":[{"gross_charge":147.5,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409773037","type":"CDM"},{"code":"00409773037","type":"NDC"}],"standard_charges":[{"gross_charge":147.5,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":219.87,"discounted_cash":153.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409781124","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409781124","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409781124","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409781124","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409781137","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409781137","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTATED RINGER'S FOR IRRIGATION","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00409782808","type":"CDM"},{"code":"00409782808","type":"NDC"}],"standard_charges":[{"gross_charge":161.74,"discounted_cash":113.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409785301","type":"CDM"},{"code":"00409785301","type":"NDC"}],"standard_charges":[{"gross_charge":678.92,"discounted_cash":475.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.2% INJ,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.225% INJ","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409790103","type":"CDM"},{"code":"00409790103","type":"NDC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.2% INJ,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.225% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790109","type":"CDM"},{"code":"00409790109","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409790203","type":"CDM"},{"code":"00409790203","type":"NDC"}],"standard_charges":[{"gross_charge":160.76,"discounted_cash":112.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409790209","type":"CDM"},{"code":"00409790209","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790309","type":"CDM"},{"code":"00409790309","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409790409","type":"CDM"},{"code":"00409790409","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN DEXTROSE 5% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790509","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409790509","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792202","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792202","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792203","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792203","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792209","type":"CDM"},{"code":"J7070","type":"HCPCS"},{"code":"00409792209","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792402","type":"CDM"},{"code":"00409792402","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792403","type":"CDM"},{"code":"00409792403","type":"NDC"}],"standard_charges":[{"gross_charge":146.14,"discounted_cash":102.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792409","type":"CDM"},{"code":"00409792409","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792602","type":"CDM"},{"code":"00409792602","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792603","type":"CDM"},{"code":"00409792603","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792609","type":"CDM"},{"code":"00409792609","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.84,"discounted_cash":103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792909","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00409792909","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409793002","type":"CDM"},{"code":"00409793002","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409793003","type":"CDM"},{"code":"00409793003","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409794103","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00409794103","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409794109","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00409794109","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409795303","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00409795303","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409795309","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00409795309","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409796709","type":"CDM"},{"code":"00409796709","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00409797207","type":"CDM"},{"code":"00409797207","type":"NDC"}],"standard_charges":[{"gross_charge":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00409797208","type":"CDM"},{"code":"00409797208","type":"NDC"}],"standard_charges":[{"gross_charge":161.74,"discounted_cash":113.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCINE IRRIGATION SOLN 1.5%","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00409797408","type":"CDM"},{"code":"00409797408","type":"NDC"}],"standard_charges":[{"gross_charge":190.8,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798302","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798302","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798325","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798325","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00409798361","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798361","type":"NDC"}],"standard_charges":[{"gross_charge":162.32,"discounted_cash":113.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":153.25,"discounted_cash":107.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798411","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798411","type":"NDC"}],"standard_charges":[{"gross_charge":167.1,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798413","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798413","type":"NDC"}],"standard_charges":[{"gross_charge":163.69,"discounted_cash":114.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798423","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798423","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798502","type":"CDM"},{"code":"00409798502","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798503","type":"CDM"},{"code":"00409798503","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409798509","type":"CDM"},{"code":"00409798509","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409799309","type":"CDM"},{"code":"00409799309","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904216","type":"CDM"},{"code":"00409904216","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904217","type":"CDM"},{"code":"00409904217","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409904301","type":"CDM"},{"code":"00409904301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904501","type":"CDM"},{"code":"00409904501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904517","type":"CDM"},{"code":"00409904517","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409909335","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909335","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909422","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409909425","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409909431","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909431","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915801","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915825","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915825","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915831","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915831","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915850","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915850","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409930020","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"00409930020","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409930021","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"00409930021","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409930130","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"00409930130","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409930131","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"00409930131","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00409955805","type":"CDM"},{"code":"00409955805","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409955869","type":"CDM"},{"code":"00409955869","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESTRADIOL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00430072224","type":"CDM"},{"code":"00430072224","type":"NDC"}],"standard_charges":[{"gross_charge":22.11,"discounted_cash":15.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESALAMINE CAP DR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00430075327","type":"CDM"},{"code":"00430075327","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESALAMINE TAB DELAYED RELEASE 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00430078327","type":"CDM"},{"code":"00430078327","type":"NDC"}],"standard_charges":[{"gross_charge":23.81,"discounted_cash":16.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.125%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00436067216","type":"CDM"},{"code":"00436067216","type":"NDC"}],"standard_charges":[{"gross_charge":17.97,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.25%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00436093616","type":"CDM"},{"code":"00436093616","type":"NDC"}],"standard_charges":[{"gross_charge":17.97,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.5%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00436094616","type":"CDM"},{"code":"00436094616","type":"NDC"}],"standard_charges":[{"gross_charge":17.97,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THYROID TAB 30 MG (1/2 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456045801","type":"CDM"},{"code":"00456045801","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.04,"discounted_cash":8.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456060001","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456060001","type":"NDC"}],"standard_charges":[{"gross_charge":613.74,"discounted_cash":429.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456060010","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456060010","type":"NDC"}],"standard_charges":[{"gross_charge":2411.32,"discounted_cash":1687.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VILAZODONE HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456114030","type":"CDM"},{"code":"00456114030","type":"NDC"}],"standard_charges":[{"gross_charge":30.96,"discounted_cash":21.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456201001","type":"CDM"},{"code":"00456201001","type":"NDC"}],"standard_charges":[{"gross_charge":36.48,"discounted_cash":25.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME-AVIBACTAM SODIUM FOR IV SOLN 2.5 GM (2-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456270001","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270001","type":"NDC"}],"standard_charges":[{"gross_charge":1475.68,"discounted_cash":1032.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME-AVIBACTAM SODIUM FOR IV SOLN 2.5 GM (2-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456270010","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270010","type":"NDC"}],"standard_charges":[{"gross_charge":1476.16,"discounted_cash":1033.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456320511","type":"CDM"},{"code":"00456320511","type":"NDC"}],"standard_charges":[{"gross_charge":22.96,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456430001","type":"CDM"},{"code":"00456430001","type":"NDC"}],"standard_charges":[{"gross_charge":131.53,"discounted_cash":92.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456430008","type":"CDM"},{"code":"00456430008","type":"NDC"}],"standard_charges":[{"gross_charge":148.44,"discounted_cash":103.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENZALUTAMIDE CAP 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469012599","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00469012599","type":"NDC"}],"standard_charges":[{"gross_charge":241.24,"discounted_cash":168.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISAVUCONAZONIUM SULFATE FOR IV SOLN 372 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469042001","type":"CDM"},{"code":"J1833","type":"HCPCS"},{"code":"00469042001","type":"NDC"}],"standard_charges":[{"gross_charge":1473.49,"discounted_cash":1031.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISAVUCONAZONIUM SULFATE CAP 186 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469052001","type":"CDM"},{"code":"00469052001","type":"NDC"}],"standard_charges":[{"gross_charge":193.68,"discounted_cash":135.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISAVUCONAZONIUM SULFATE CAP 186 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469052002","type":"CDM"},{"code":"00469052002","type":"NDC"}],"standard_charges":[{"gross_charge":208.51,"discounted_cash":145.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469060773","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00469060773","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22.8,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469065773","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00469065773","type":"NDC"}],"standard_charges":[{"gross_charge":73.55,"discounted_cash":51.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":954.04,"discounted_cash":667.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1261.83,"discounted_cash":883.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469325010","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"00469325010","type":"NDC"}],"standard_charges":[{"gross_charge":1108.48,"discounted_cash":775.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00472008216","type":"CDM"},{"code":"00472008216","type":"NDC"}],"standard_charges":[{"gross_charge":16.66,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00472016615","type":"CDM"},{"code":"00472016615","type":"NDC"}],"standard_charges":[{"gross_charge":87.98,"discounted_cash":61.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PERMETHRIN CREAM 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00472024260","type":"CDM"},{"code":"00472024260","type":"NDC"}],"standard_charges":[{"gross_charge":311.76,"discounted_cash":218.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":77.57,"discounted_cash":54.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL CREAM 2%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00472073041","type":"CDM"},{"code":"00472073041","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALBUTEROL SULFATE SYRUP 2 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00472082516","type":"CDM"},{"code":"00472082516","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL SUPPOS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00472173803","type":"CDM"},{"code":"00472173803","type":"NDC"}],"standard_charges":[{"gross_charge":37.4,"discounted_cash":26.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PERAMPANEL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00480706256","type":"CDM"},{"code":"00480706256","type":"NDC"}],"standard_charges":[{"gross_charge":42.15,"discounted_cash":29.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487020103","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00487020103","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RACEPINEPHRINE HCL SOLN NEBU 2.25% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00487590199","type":"CDM"},{"code":"00487590199","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487900360","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00487900360","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 7%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00487900730","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00487900730","type":"NDC"}],"standard_charges":[{"gross_charge":11.27,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 7%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00487900760","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00487900760","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00487970101","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":12.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00487980101","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00487980101","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9.85,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.97,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517003125","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDIGOTINDISULFONATE SODIUM INJ 8 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00517037505","type":"CDM"},{"code":"J9220","type":"HCPCS"},{"code":"00517037505","type":"NDC"}],"standard_charges":[{"gross_charge":1862.63,"discounted_cash":1303.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4163.13,"discounted_cash":2914.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1909.76,"discounted_cash":1336.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":111.39,"discounted_cash":77.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517073001","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"00517073001","type":"NDC"}],"standard_charges":[{"gross_charge":618.98,"discounted_cash":433.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":338.19,"discounted_cash":236.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":334.53,"discounted_cash":234.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":325.69,"discounted_cash":227.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00517095501","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00517095501","type":"NDC"}],"standard_charges":[{"gross_charge":575.42,"discounted_cash":402.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00517117110","type":"CDM"},{"code":"00517117110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":167.66,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":167.66,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":167.66,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":492.48,"discounted_cash":344.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517271025","type":"CDM"},{"code":"00517271025","type":"NDC"}],"standard_charges":[{"gross_charge":275.38,"discounted_cash":192.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517301025","type":"CDM"},{"code":"00517301025","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517400225","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"00517400225","type":"NDC"}],"standard_charges":[{"gross_charge":242.28,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE HCL IM SOLN 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517420125","type":"CDM"},{"code":"J3410","type":"HCPCS"},{"code":"00517420125","type":"NDC"}],"standard_charges":[{"gross_charge":267.51,"discounted_cash":187.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3069.95,"discounted_cash":2148.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":172.19,"discounted_cash":120.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":192.86,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZINC SULFATE INJ 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517611025","type":"CDM"},{"code":"00517611025","type":"NDC"}],"standard_charges":[{"gross_charge":232.14,"discounted_cash":162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRACE MIN (CR-CU-MN-ZN) INJ 0.85-100-25-1500 MCG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517620225","type":"CDM"},{"code":"00517620225","type":"NDC"}],"standard_charges":[{"gross_charge":154.45,"discounted_cash":108.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SELENIOUS ACID INJ 60 MCG/ML (SELENIUM EQUIV)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517656005","type":"CDM"},{"code":"00517656005","type":"NDC"}],"standard_charges":[{"gross_charge":869.81,"discounted_cash":608.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517671001","type":"CDM"},{"code":"00517671001","type":"NDC"}],"standard_charges":[{"gross_charge":118.45,"discounted_cash":82.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517671010","type":"CDM"},{"code":"00517671010","type":"NDC"}],"standard_charges":[{"gross_charge":118.45,"discounted_cash":82.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.21,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19.55,"discounted_cash":13.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZINC SULFATE INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00517810525","type":"CDM"},{"code":"00517810525","type":"NDC"}],"standard_charges":[{"gross_charge":592.19,"discounted_cash":414.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517912001","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00517912001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00517912025","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00517912025","type":"NDC"}],"standard_charges":[{"gross_charge":116.7,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517919125","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00517919125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRACE MIN (CR-CU-MN-ZN) INJ 1-100-25-1000 MCG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00517920325","type":"CDM"},{"code":"00517920325","type":"NDC"}],"standard_charges":[{"gross_charge":157.64,"discounted_cash":110.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRACE MIN (CU-MN-SE-ZN) INJ 60-3-6-1000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517930201","type":"CDM"},{"code":"00517930201","type":"NDC"}],"standard_charges":[{"gross_charge":227.99,"discounted_cash":159.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":368.54,"discounted_cash":257.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517970201","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00517970201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517970225","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00517970225","type":"NDC"}],"standard_charges":[{"gross_charge":115.46,"discounted_cash":80.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527058601","type":"CDM"},{"code":"00527058601","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527111610","type":"CDM"},{"code":"00527111610","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17.69,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":42.84,"discounted_cash":29.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COCAINE HCL NASAL SOLN 40 MG/ML (4%)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00527196174","type":"CDM"},{"code":"C9046","type":"HCPCS"},{"code":"00527196174","type":"NDC"}],"standard_charges":[{"gross_charge":392.63,"discounted_cash":274.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COCAINE HCL NASAL SOLN 40 MG/ML (4%)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00527197174","type":"CDM"},{"code":"C9143","type":"HCPCS"},{"code":"00527197174","type":"NDC"}],"standard_charges":[{"gross_charge":371.21,"discounted_cash":259.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527328646","type":"CDM"},{"code":"00527328646","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527411737","type":"CDM"},{"code":"00527411737","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LISDEXAMFETAMINE DIMESYLATE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527466137","type":"CDM"},{"code":"00527466137","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00527516082","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00527516082","type":"NDC"}],"standard_charges":[{"gross_charge":13.94,"discounted_cash":9.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBAZAM SUSPENSION 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00527530164","type":"CDM"},{"code":"00527530164","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00527600480","type":"CDM"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":112.84,"discounted_cash":78.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALUMINUM HYDROXIDE GEL SUSP 320 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536009185","type":"CDM"},{"code":"00536009185","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETRAHYDROZOLINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536100294","type":"CDM"},{"code":"00536100294","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536100410","type":"CDM"},{"code":"00536100410","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536100441","type":"CDM"},{"code":"00536100441","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536101294","type":"CDM"},{"code":"00536101294","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL POWDER 17 GM/SCOOP","drug_information":{"unit":238.0,"type":"GM"},"code_information":[{"code":"Rx00536105224","type":"CDM"},{"code":"00536105224","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536105305","type":"CDM"},{"code":"00536105305","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZOYL PEROXIDE GEL 5%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx00536105556","type":"CDM"},{"code":"00536105556","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536110688","type":"CDM"},{"code":"00536110688","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536110788","type":"CDM"},{"code":"00536110788","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536110888","type":"CDM"},{"code":"00536110888","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"UREA CREAM 20%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx00536110945","type":"CDM"},{"code":"00536110945","type":"NDC"}],"standard_charges":[{"gross_charge":6.63,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIBUCAINE OINT 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536121195","type":"CDM"},{"code":"00536121195","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETRAHYDROZOLINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536121794","type":"CDM"},{"code":"00536121794","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx00536122858","type":"CDM"},{"code":"00536122858","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAMPHOR & MENTHOL LOTION 0.5-0.5%","drug_information":{"unit":222.0,"type":"ML"},"code_information":[{"code":"Rx00536126812","type":"CDM"},{"code":"00536126812","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.22,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00536130375","type":"CDM"},{"code":"00536130375","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4.5,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB 250-250-65 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536132601","type":"CDM"},{"code":"00536132601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLECALCIFEROL ORAL LIQUID 10 MCG/ML (400 UNIT/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00536134380","type":"CDM"},{"code":"00536134380","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":2.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE SOLN 75 MG/ML (15 MG/ML ELEMENTAL FE)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00536134480","type":"CDM"},{"code":"00536134480","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMIN DROPS","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00536134580","type":"CDM"},{"code":"00536134580","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS W/ IRON DROPS 11 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00536134680","type":"CDM"},{"code":"00536134680","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":5.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536136223","type":"CDM"},{"code":"00536136223","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536137575","type":"CDM"},{"code":"00536137575","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536140795","type":"CDM"},{"code":"00536140795","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYVINYL ALCOHOL OPHTH SOLN 1.4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536140894","type":"CDM"},{"code":"00536140894","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SELENIUM SULFIDE LOTION 1%","drug_information":{"unit":207.0,"type":"ML"},"code_information":[{"code":"Rx00536199553","type":"CDM"},{"code":"00536199553","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAPSAICIN CREAM 0.025%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00536252525","type":"CDM"},{"code":"00536252525","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536330501","type":"CDM"},{"code":"00536330501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BISACODYL TAB DELAYED RELEASE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536338101","type":"CDM"},{"code":"00536338101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS W/ IRON CHEW TAB 18 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536344308","type":"CDM"},{"code":"00536344308","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536354201","type":"CDM"},{"code":"00536354201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MECLIZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536398501","type":"CDM"},{"code":"00536398501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536430605","type":"CDM"},{"code":"00536430605","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536440601","type":"CDM"},{"code":"00536440601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536454410","type":"CDM"},{"code":"00536454410","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589488","type":"CDM"},{"code":"00536589488","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589533","type":"CDM"},{"code":"00536589533","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.56,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589633","type":"CDM"},{"code":"00536589633","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589688","type":"CDM"},{"code":"00536589688","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536781710","type":"CDM"},{"code":"00536781710","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00548560100","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560100","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00548560200","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560200","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ 300 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00548560800","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560800","type":"NDC"}],"standard_charges":[{"gross_charge":473.18,"discounted_cash":331.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":291.57,"discounted_cash":204.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548950200","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00548950200","type":"NDC"}],"standard_charges":[{"gross_charge":534.3,"discounted_cash":374.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555048527","type":"CDM"},{"code":"00555048527","type":"NDC"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":17.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555076402","type":"CDM"},{"code":"00555076402","type":"NDC"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":13.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRETINOIN CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555080802","type":"CDM"},{"code":"00555080802","type":"NDC"}],"standard_charges":[{"gross_charge":56.23,"discounted_cash":39.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555087202","type":"CDM"},{"code":"00555087202","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESTRADIOL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555088702","type":"CDM"},{"code":"00555088702","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALTREXONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555090201","type":"CDM"},{"code":"00555090201","type":"NDC"}],"standard_charges":[{"gross_charge":15.09,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.43,"discounted_cash":8.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROAMPHETAMINE SULFATE CAP ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555095402","type":"CDM"},{"code":"00555095402","type":"NDC"}],"standard_charges":[{"gross_charge":16.48,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555097202","type":"CDM"},{"code":"00555097202","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555100901","type":"CDM"},{"code":"00555100901","type":"NDC"}],"standard_charges":[{"gross_charge":36.11,"discounted_cash":25.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555100916","type":"CDM"},{"code":"00555100916","type":"NDC"}],"standard_charges":[{"gross_charge":56.43,"discounted_cash":39.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780500","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780500","type":"NDC"}],"standard_charges":[{"gross_charge":1042.54,"discounted_cash":729.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00573017920","type":"CDM"},{"code":"00573017920","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00573055607","type":"CDM"},{"code":"00573055607","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00573055620","type":"CDM"},{"code":"00573055620","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00573055696","type":"CDM"},{"code":"00573055696","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00573055807","type":"CDM"},{"code":"00573055807","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574006915","type":"CDM"},{"code":"00574006915","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.42,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BROMOCRIPTINE MESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010603","type":"CDM"},{"code":"00574010603","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00574012901","type":"CDM"},{"code":"00574012901","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574022001","type":"CDM"},{"code":"00574022001","type":"NDC"}],"standard_charges":[{"gross_charge":11.13,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574022201","type":"CDM"},{"code":"00574022201","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB ER 12HR 0.375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574025101","type":"CDM"},{"code":"00574025101","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574029201","type":"CDM"},{"code":"00574029201","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ORAL VEHICLES - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00574030216","type":"CDM"},{"code":"00574030216","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.55,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ORAL VEHICLES - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00574030416","type":"CDM"},{"code":"00574030416","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574079201","type":"CDM"},{"code":"00574079201","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00574080530","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"00574080530","type":"NDC"}],"standard_charges":[{"gross_charge":559.52,"discounted_cash":391.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1557.05,"discounted_cash":1089.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1479.2,"discounted_cash":1035.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOSPORINE IV SOLN 50 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00574086610","type":"CDM"},{"code":"J7516","type":"HCPCS"},{"code":"00574086610","type":"NDC"}],"standard_charges":[{"gross_charge":570.49,"discounted_cash":399.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OPHTH OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00574402135","type":"CDM"},{"code":"00574402135","type":"NDC"}],"standard_charges":[{"gross_charge":108.86,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACITRACIN OPHTH OINT 500 UNIT/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00574402235","type":"CDM"},{"code":"00574402235","type":"NDC"}],"standard_charges":[{"gross_charge":335.86,"discounted_cash":235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00574402411","type":"CDM"},{"code":"00574402411","type":"NDC"}],"standard_charges":[{"gross_charge":66.91,"discounted_cash":46.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":114.91,"discounted_cash":80.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00574416035","type":"CDM"},{"code":"00574416035","type":"NDC"}],"standard_charges":[{"gross_charge":84.35,"discounted_cash":59.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN SUPPOS 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574703412","type":"CDM"},{"code":"00574703412","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BELLADONNA ALKALOIDS & OPIUM SUPPOS 16.2-60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574704001","type":"CDM"},{"code":"00574704001","type":"NDC"}],"standard_charges":[{"gross_charge":52.92,"discounted_cash":37.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BELLADONNA ALKALOIDS & OPIUM SUPPOS 16.2-60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574704012","type":"CDM"},{"code":"00574704012","type":"NDC"}],"standard_charges":[{"gross_charge":57.42,"discounted_cash":40.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BELLADONNA ALKALOIDS & OPIUM SUPPOS 16.2-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574704512","type":"CDM"},{"code":"00574704512","type":"NDC"}],"standard_charges":[{"gross_charge":49.28,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574709012","type":"CDM"},{"code":"00574709012","type":"NDC"}],"standard_charges":[{"gross_charge":30.19,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574711212","type":"CDM"},{"code":"00574711212","type":"NDC"}],"standard_charges":[{"gross_charge":22.01,"discounted_cash":15.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00591014926","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00591014926","type":"NDC"}],"standard_charges":[{"gross_charge":206.3,"discounted_cash":144.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591044401","type":"CDM"},{"code":"00591044401","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591078001","type":"CDM"},{"code":"00591078001","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591080001","type":"CDM"},{"code":"00591080001","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx00591081083","type":"CDM"},{"code":"00591081083","type":"NDC"}],"standard_charges":[{"gross_charge":67.05,"discounted_cash":46.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00591212779","type":"CDM"},{"code":"00591212779","type":"NDC"}],"standard_charges":[{"gross_charge":833.59,"discounted_cash":583.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN B GU IRRIGATION SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00591219054","type":"CDM"},{"code":"00591219054","type":"NDC"}],"standard_charges":[{"gross_charge":175.27,"discounted_cash":122.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 18 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591271501","type":"CDM"},{"code":"00591271501","type":"NDC"}],"standard_charges":[{"gross_charge":24.98,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 27 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591271601","type":"CDM"},{"code":"00591271601","type":"NDC"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":17.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 36 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591271701","type":"CDM"},{"code":"00591271701","type":"NDC"}],"standard_charges":[{"gross_charge":25.89,"discounted_cash":18.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL TARTRATE INHAL AEROSOL 45 MCG/ACT (BASE EQUIV)","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00591292754","type":"CDM"},{"code":"00591292754","type":"NDC"}],"standard_charges":[{"gross_charge":196.5,"discounted_cash":137.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROGESTERONE IM IN OIL 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00591312879","type":"CDM"},{"code":"J2675","type":"HCPCS"},{"code":"00591312879","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591319854","type":"CDM"},{"code":"00591319854","type":"NDC"}],"standard_charges":[{"gross_charge":38.53,"discounted_cash":26.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591319872","type":"CDM"},{"code":"00591319872","type":"NDC"}],"standard_charges":[{"gross_charge":23.95,"discounted_cash":16.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591320301","type":"CDM"},{"code":"00591320301","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321254","type":"CDM"},{"code":"00591321254","type":"NDC"}],"standard_charges":[{"gross_charge":60.87,"discounted_cash":42.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321354","type":"CDM"},{"code":"00591321354","type":"NDC"}],"standard_charges":[{"gross_charge":86.8,"discounted_cash":60.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321372","type":"CDM"},{"code":"00591321372","type":"NDC"}],"standard_charges":[{"gross_charge":46.38,"discounted_cash":32.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321454","type":"CDM"},{"code":"00591321454","type":"NDC"}],"standard_charges":[{"gross_charge":111.42,"discounted_cash":77.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUTALBITAL-ASPIRIN-CAFFEINE CAP 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321901","type":"CDM"},{"code":"00591321901","type":"NDC"}],"standard_charges":[{"gross_charge":13.41,"discounted_cash":9.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591336901","type":"CDM"},{"code":"00591336901","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591350854","type":"CDM"},{"code":"00591350854","type":"NDC"}],"standard_charges":[{"gross_charge":55.7,"discounted_cash":38.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591350904","type":"CDM"},{"code":"00591350904","type":"NDC"}],"standard_charges":[{"gross_charge":87.7,"discounted_cash":61.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591350954","type":"CDM"},{"code":"00591350954","type":"NDC"}],"standard_charges":[{"gross_charge":86.87,"discounted_cash":60.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.3 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591351054","type":"CDM"},{"code":"00591351054","type":"NDC"}],"standard_charges":[{"gross_charge":116.59,"discounted_cash":81.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.14,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.63,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387044","type":"CDM"},{"code":"00591387044","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387045","type":"CDM"},{"code":"00591387045","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEPROBAMATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591523801","type":"CDM"},{"code":"00591523801","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591533501","type":"CDM"},{"code":"00591533501","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591555501","type":"CDM"},{"code":"00591555501","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591578601","type":"CDM"},{"code":"00591578601","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591588301","type":"CDM"},{"code":"00591588301","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597000160","type":"CDM"},{"code":"00597000160","type":"NDC"}],"standard_charges":[{"gross_charge":26.36,"discounted_cash":18.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1155.2,"discounted_cash":808.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597003134","type":"CDM"},{"code":"00597003134","type":"NDC"}],"standard_charges":[{"gross_charge":135.48,"discounted_cash":94.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TELMISARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597004037","type":"CDM"},{"code":"00597004037","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TELMISARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597004137","type":"CDM"},{"code":"00597004137","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":75.67,"discounted_cash":52.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":860.73,"discounted_cash":602.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIOTROPIUM BROMIDE INHAL AEROSOL 2.5 MCG/ACT","drug_information":{"unit":4.0,"type":"GM"},"code_information":[{"code":"Rx00597010051","type":"CDM"},{"code":"00597010051","type":"NDC"}],"standard_charges":[{"gross_charge":116.49,"discounted_cash":81.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 110 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597010860","type":"CDM"},{"code":"00597010860","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597014960","type":"CDM"},{"code":"00597014960","type":"NDC"}],"standard_charges":[{"gross_charge":20.58,"discounted_cash":14.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015230","type":"CDM"},{"code":"00597015230","type":"NDC"}],"standard_charges":[{"gross_charge":27.26,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":27.26,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597018390","type":"CDM"},{"code":"00597018390","type":"NDC"}],"standard_charges":[{"gross_charge":22.36,"discounted_cash":15.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20713.75,"discounted_cash":14499.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597036055","type":"CDM"},{"code":"00597036055","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597036082","type":"CDM"},{"code":"00597036082","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00603116158","type":"CDM"},{"code":"00603116158","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00603154258","type":"CDM"},{"code":"00603154258","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603155404","type":"CDM"},{"code":"00603155404","type":"NDC"}],"standard_charges":[{"gross_charge":22.66,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603155410","type":"CDM"},{"code":"00603155410","type":"NDC"}],"standard_charges":[{"gross_charge":22.61,"discounted_cash":15.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603155416","type":"CDM"},{"code":"00603155416","type":"NDC"}],"standard_charges":[{"gross_charge":23.32,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.72,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BISACODYL TAB DELAYED RELEASE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603248321","type":"CDM"},{"code":"00603248321","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603318021","type":"CDM"},{"code":"00603318021","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603358121","type":"CDM"},{"code":"00603358121","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603390021","type":"CDM"},{"code":"00603390021","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603448521","type":"CDM"},{"code":"00603448521","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603448621","type":"CDM"},{"code":"00603448621","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603465316","type":"CDM"},{"code":"00603465316","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603465402","type":"CDM"},{"code":"00603465402","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603533521","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00603533521","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603548221","type":"CDM"},{"code":"00603548221","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603548321","type":"CDM"},{"code":"00603548321","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603580121","type":"CDM"},{"code":"00603580121","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx00603780550","type":"CDM"},{"code":"00603780550","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00603781874","type":"CDM"},{"code":"00603781874","type":"NDC"}],"standard_charges":[{"gross_charge":87.64,"discounted_cash":61.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036721","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036721","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","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":11.64,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","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":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641040012","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00641040012","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641040037","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00641040037","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641041037","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00641041037","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641047621","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047621","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641047625","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047625","type":"NDC"}],"standard_charges":[{"gross_charge":206.56,"discounted_cash":144.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":213.3,"discounted_cash":149.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641095521","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641095521","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641095525","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641095525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":400.1,"discounted_cash":280.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":109.99,"discounted_cash":76.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641139835","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":331.26,"discounted_cash":231.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":268.71,"discounted_cash":188.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641601901","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641601901","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641601910","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641601910","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641602201","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"00641602201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641602225","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"00641602225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00641602701","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602701","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULF FOR MICROINFUSION PF INJ 500 MG/20ML (25MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00641604001","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641604001","type":"NDC"}],"standard_charges":[{"gross_charge":1271.23,"discounted_cash":889.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00641604201","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00641604201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604401","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604401","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604425","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604425","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604601","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604601","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604801","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604801","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641604901","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604901","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605001","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641605001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00641605701","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605701","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00641605710","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605710","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641605725","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605725","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00641605910","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605910","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641606001","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00641606010","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606010","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641606125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641608001","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641608001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611701","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641612501","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612501","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx00641614201","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641614201","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx00641614225","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641614225","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641614701","type":"CDM"},{"code":"00641614701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641614725","type":"CDM"},{"code":"00641614725","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641617301","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"00641617301","type":"NDC"}],"standard_charges":[{"gross_charge":310.24,"discounted_cash":217.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641617310","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"00641617310","type":"NDC"}],"standard_charges":[{"gross_charge":123.92,"discounted_cash":86.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617401","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617410","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641618425","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641618425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641619101","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641619101","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641619110","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641619110","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641623801","type":"CDM"},{"code":"00641623801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE TAB 325 MG (65 MG ELEMENTAL FE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00677007001","type":"CDM"},{"code":"00677007001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAMOXINE HCL PERIANAL FOAM 1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00677196579","type":"CDM"},{"code":"00677196579","type":"NDC"}],"standard_charges":[{"gross_charge":25.95,"discounted_cash":18.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZOCAINE MOUTH/THROAT AEROSOL 20%","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx00699310002","type":"CDM"},{"code":"00699310002","type":"NDC"}],"standard_charges":[{"gross_charge":39.84,"discounted_cash":27.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703011301","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00703011301","type":"NDC"}],"standard_charges":[{"gross_charge":141.87,"discounted_cash":99.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":117.42,"discounted_cash":82.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TREPROSTINIL INJ SOLN 20 MG/20ML (1 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00703066601","type":"CDM"},{"code":"J3285","type":"HCPCS"},{"code":"00703066601","type":"NDC"}],"standard_charges":[{"gross_charge":1612.25,"discounted_cash":1128.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703205601","type":"CDM"},{"code":"00703205601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703205603","type":"CDM"},{"code":"00703205603","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":466.75,"discounted_cash":326.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00703333301","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00703333301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703367103","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367103","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00703367801","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367801","type":"NDC"}],"standard_charges":[{"gross_charge":342.54,"discounted_cash":239.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00703398601","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"00703398601","type":"NDC"}],"standard_charges":[{"gross_charge":1149.41,"discounted_cash":804.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IDARUBICIN HCL IV INJ 5 MG/5ML (1 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703415411","type":"CDM"},{"code":"J9211","type":"HCPCS"},{"code":"00703415411","type":"NDC"}],"standard_charges":[{"gross_charge":946.89,"discounted_cash":662.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 600 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00703423901","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703423901","type":"NDC"}],"standard_charges":[{"gross_charge":907.28,"discounted_cash":635.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":732.53,"discounted_cash":512.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MITOXANTRONE HCL INJ CONC 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703468501","type":"CDM"},{"code":"J9293","type":"HCPCS"},{"code":"00703468501","type":"NDC"}],"standard_charges":[{"gross_charge":1954.6,"discounted_cash":1368.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPOTECAN HCL INJ 4 MG/4ML (BASE EQUIV) (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00703471401","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"00703471401","type":"NDC"}],"standard_charges":[{"gross_charge":1228.92,"discounted_cash":860.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703480501","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"00703480501","type":"NDC"}],"standard_charges":[{"gross_charge":203.05,"discounted_cash":142.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":232.22,"discounted_cash":162.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1542.36,"discounted_cash":1079.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETOPOSIDE INJ 1 GM/50ML (20 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00703565701","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00703565701","type":"NDC"}],"standard_charges":[{"gross_charge":1074.69,"discounted_cash":752.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":370.32,"discounted_cash":259.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703712101","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"00703712101","type":"NDC"}],"standard_charges":[{"gross_charge":114.67,"discounted_cash":80.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00703868023","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00703868023","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00703877601","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00703877601","type":"NDC"}],"standard_charges":[{"gross_charge":1027.15,"discounted_cash":719.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00703877701","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00703877701","type":"NDC"}],"standard_charges":[{"gross_charge":1513.58,"discounted_cash":1059.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00703906031","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00703906031","type":"NDC"}],"standard_charges":[{"gross_charge":1433.32,"discounted_cash":1003.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 1.2 GM/30ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00703941601","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"00703941601","type":"NDC"}],"standard_charges":[{"gross_charge":283.33,"discounted_cash":198.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703950303","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"00703950303","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":106.84,"discounted_cash":74.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":203.04,"discounted_cash":142.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713010109","type":"CDM"},{"code":"00713010109","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713011806","type":"CDM"},{"code":"00713011806","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713011812","type":"CDM"},{"code":"00713011812","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713016406","type":"CDM"},{"code":"00713016406","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713022515","type":"CDM"},{"code":"00713022515","type":"NDC"}],"standard_charges":[{"gross_charge":59.04,"discounted_cash":41.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713022815","type":"CDM"},{"code":"00713022815","type":"NDC"}],"standard_charges":[{"gross_charge":60.98,"discounted_cash":42.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.1,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00713035109","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"00713035109","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24.57,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713050312","type":"CDM"},{"code":"00713050312","type":"NDC"}],"standard_charges":[{"gross_charge":29.83,"discounted_cash":20.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.15,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":88.8,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713068615","type":"CDM"},{"code":"00713068615","type":"NDC"}],"standard_charges":[{"gross_charge":58.69,"discounted_cash":41.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00731040106","type":"CDM"},{"code":"00731040106","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP DELAYED RELEASE 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00761017120","type":"CDM"},{"code":"00761017120","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00761055520","type":"CDM"},{"code":"00761055520","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781118101","type":"CDM"},{"code":"00781118101","type":"NDC"}],"standard_charges":[{"gross_charge":14.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781148801","type":"CDM"},{"code":"00781148801","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781155613","type":"CDM"},{"code":"00781155613","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781165501","type":"CDM"},{"code":"00781165501","type":"NDC"}],"standard_charges":[{"gross_charge":11.73,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781169501","type":"CDM"},{"code":"00781169501","type":"NDC"}],"standard_charges":[{"gross_charge":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781169513","type":"CDM"},{"code":"00781169513","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781176413","type":"CDM"},{"code":"00781176413","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 250-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781187431","type":"CDM"},{"code":"00781187431","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.79,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781197101","type":"CDM"},{"code":"00781197101","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781205301","type":"CDM"},{"code":"00781205301","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781206701","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00781206701","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781207601","type":"CDM"},{"code":"00781207601","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781208102","type":"CDM"},{"code":"00781208102","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781210201","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00781210201","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781210301","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00781210301","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781210401","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00781210401","type":"NDC"}],"standard_charges":[{"gross_charge":16.29,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781225801","type":"CDM"},{"code":"00781225801","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781232206","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00781232206","type":"NDC"}],"standard_charges":[{"gross_charge":292.49,"discounted_cash":204.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781232268","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00781232268","type":"NDC"}],"standard_charges":[{"gross_charge":245.94,"discounted_cash":172.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781232306","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00781232306","type":"NDC"}],"standard_charges":[{"gross_charge":449.74,"discounted_cash":314.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781232368","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"00781232368","type":"NDC"}],"standard_charges":[{"gross_charge":378.6,"discounted_cash":265.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL CAP ER 24HR 20 MG (LA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781236201","type":"CDM"},{"code":"00781236201","type":"NDC"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261460","type":"CDM"},{"code":"00781261460","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261513","type":"CDM"},{"code":"00781261513","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":10.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMOZOLOMIDE CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781269175","type":"CDM"},{"code":"J8700","type":"HCPCS"},{"code":"00781269175","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":12.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMOZOLOMIDE CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781269275","type":"CDM"},{"code":"J8700","type":"HCPCS"},{"code":"00781269275","type":"NDC"}],"standard_charges":[{"gross_charge":37.91,"discounted_cash":26.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781300094","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781300094","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781300095","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781300095","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781309894","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781309894","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781309895","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781309895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00781311090","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311090","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00781311095","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311095","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ 300 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781312293","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781312293","type":"NDC"}],"standard_charges":[{"gross_charge":2454.74,"discounted_cash":1718.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781312485","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781312485","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781315380","type":"CDM"},{"code":"00781315380","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781315395","type":"CDM"},{"code":"00781315395","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00781315606","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"00781315606","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1227.36,"discounted_cash":859.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1093.41,"discounted_cash":765.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":232.93,"discounted_cash":163.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781317471","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"00781317471","type":"NDC"}],"standard_charges":[{"gross_charge":1001.19,"discounted_cash":700.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00781320470","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00781320470","type":"NDC"}],"standard_charges":[{"gross_charge":366.81,"discounted_cash":256.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320785","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320785","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320795","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320795","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320895","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320990","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320990","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320995","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320995","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781321046","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781321046","type":"NDC"}],"standard_charges":[{"gross_charge":186.98,"discounted_cash":130.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781322075","type":"CDM"},{"code":"00781322075","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781322095","type":"CDM"},{"code":"00781322095","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781322402","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781322402","type":"NDC"}],"standard_charges":[{"gross_charge":260.58,"discounted_cash":182.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00781323434","type":"CDM"},{"code":"J1595","type":"HCPCS"},{"code":"00781323434","type":"NDC"}],"standard_charges":[{"gross_charge":621.48,"discounted_cash":435.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00781323471","type":"CDM"},{"code":"J1595","type":"HCPCS"},{"code":"00781323471","type":"NDC"}],"standard_charges":[{"gross_charge":698.07,"discounted_cash":488.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN 200 MG/100ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00781323946","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00781323946","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781324494","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"00781324494","type":"NDC"}],"standard_charges":[{"gross_charge":1078.44,"discounted_cash":754.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2305.94,"discounted_cash":1614.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00781326268","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326268","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00781326971","type":"CDM"},{"code":"00781326971","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 300 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328809","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328809","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 300 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328891","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328891","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":148.12,"discounted_cash":103.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781329772","type":"CDM"},{"code":"00781329772","type":"NDC"}],"standard_charges":[{"gross_charge":152.92,"discounted_cash":107.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.91,"discounted_cash":103.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":116.26,"discounted_cash":81.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":151.62,"discounted_cash":106.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781331275","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"00781331275","type":"NDC"}],"standard_charges":[{"gross_charge":142.94,"discounted_cash":100.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARGATROBAN IV SOLN 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781331491","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"00781331491","type":"NDC"}],"standard_charges":[{"gross_charge":1547.43,"discounted_cash":1083.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00781331780","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"00781331780","type":"NDC"}],"standard_charges":[{"gross_charge":226.51,"discounted_cash":158.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00781334355","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00781334355","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":272.93,"discounted_cash":191.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781335666","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781335666","type":"NDC"}],"standard_charges":[{"gross_charge":272.93,"discounted_cash":191.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00781336794","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781336794","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx00781336795","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781336795","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR IV SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340946","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340946","type":"NDC"}],"standard_charges":[{"gross_charge":1033.31,"discounted_cash":723.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR IV SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340995","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340995","type":"NDC"}],"standard_charges":[{"gross_charge":1033.31,"discounted_cash":723.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781341170","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00781341170","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781341195","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00781341195","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781341694","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"00781341694","type":"NDC"}],"standard_charges":[{"gross_charge":253.12,"discounted_cash":177.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00781342804","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781342804","type":"NDC"}],"standard_charges":[{"gross_charge":195.08,"discounted_cash":136.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":527.7,"discounted_cash":369.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781344071","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"00781344071","type":"NDC"}],"standard_charges":[{"gross_charge":259.98,"discounted_cash":181.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":473.8,"discounted_cash":331.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781345070","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00781345070","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781345170","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00781345170","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781345875","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00781345875","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781345895","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00781345895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781348170","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"00781348170","type":"NDC"}],"standard_charges":[{"gross_charge":1155.61,"discounted_cash":808.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781354310","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781354310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781354325","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781354325","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00781365505","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781365505","type":"NDC"}],"standard_charges":[{"gross_charge":205.03,"discounted_cash":143.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781517501","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00781517501","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781517505","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00781517505","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781518092","type":"CDM"},{"code":"00781518092","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781518792","type":"CDM"},{"code":"00781518792","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781521801","type":"CDM"},{"code":"00781521801","type":"NDC"}],"standard_charges":[{"gross_charge":12.23,"discounted_cash":8.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523806","type":"CDM"},{"code":"00781523806","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523864","type":"CDM"},{"code":"00781523864","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523906","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00781523906","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523964","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00781523964","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531106","type":"CDM"},{"code":"00781531106","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531108","type":"CDM"},{"code":"00781531108","type":"NDC"}],"standard_charges":[{"gross_charge":17.99,"discounted_cash":12.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531206","type":"CDM"},{"code":"00781531206","type":"NDC"}],"standard_charges":[{"gross_charge":19.48,"discounted_cash":13.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531208","type":"CDM"},{"code":"00781531208","type":"NDC"}],"standard_charges":[{"gross_charge":20.81,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531701","type":"CDM"},{"code":"00781531701","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781540192","type":"CDM"},{"code":"00781540192","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781540292","type":"CDM"},{"code":"00781540292","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781540964","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00781540964","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781555431","type":"CDM"},{"code":"00781555431","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781555531","type":"CDM"},{"code":"00781555531","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781570192","type":"CDM"},{"code":"00781570192","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781574801","type":"CDM"},{"code":"00781574801","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00781601470","type":"CDM"},{"code":"00781601470","type":"NDC"}],"standard_charges":[{"gross_charge":834.74,"discounted_cash":584.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604146","type":"CDM"},{"code":"00781604146","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604155","type":"CDM"},{"code":"00781604155","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx00781607761","type":"CDM"},{"code":"00781607761","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":13.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00781610446","type":"CDM"},{"code":"00781610446","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781613948","type":"CDM"},{"code":"00781613948","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE OTIC SUSP 0.3-0.1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00781618667","type":"CDM"},{"code":"00781618667","type":"NDC"}],"standard_charges":[{"gross_charge":650.94,"discounted_cash":455.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx00781707787","type":"CDM"},{"code":"00781707787","type":"NDC"}],"standard_charges":[{"gross_charge":373.65,"discounted_cash":261.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781710454","type":"CDM"},{"code":"00781710454","type":"NDC"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781713593","type":"CDM"},{"code":"00781713593","type":"NDC"}],"standard_charges":[{"gross_charge":126.58,"discounted_cash":88.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781717612","type":"CDM"},{"code":"00781717612","type":"NDC"}],"standard_charges":[{"gross_charge":51.97,"discounted_cash":36.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781723864","type":"CDM"},{"code":"00781723864","type":"NDC"}],"standard_charges":[{"gross_charge":24.21,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781801801","type":"CDM"},{"code":"00781801801","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00781903895","type":"CDM"},{"code":"00781903895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781912485","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781912485","type":"NDC"}],"standard_charges":[{"gross_charge":171.6,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781922109","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781922109","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781922191","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781922191","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARGATROBAN IV SOLN 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781931491","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"00781931491","type":"NDC"}],"standard_charges":[{"gross_charge":1871.59,"discounted_cash":1310.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00781932470","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00781932470","type":"NDC"}],"standard_charges":[{"gross_charge":319.74,"discounted_cash":223.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940778","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940778","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR IV SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940995","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940995","type":"NDC"}],"standard_charges":[{"gross_charge":1022.16,"discounted_cash":715.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832030200","type":"CDM"},{"code":"00832030200","type":"NDC"}],"standard_charges":[{"gross_charge":19.42,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832030289","type":"CDM"},{"code":"00832030289","type":"NDC"}],"standard_charges":[{"gross_charge":23.78,"discounted_cash":16.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":79.26,"discounted_cash":55.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBAZAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832058011","type":"CDM"},{"code":"00832058011","type":"NDC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832101500","type":"CDM"},{"code":"00832101500","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":8.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832108100","type":"CDM"},{"code":"00832108100","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121501","type":"CDM"},{"code":"00832121501","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WARFARIN SODIUM TAB 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121789","type":"CDM"},{"code":"00832121789","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WARFARIN SODIUM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121889","type":"CDM"},{"code":"00832121889","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832201200","type":"CDM"},{"code":"00832201200","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":9.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832601700","type":"CDM"},{"code":"00832601700","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712211","type":"CDM"},{"code":"00832712211","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712401","type":"CDM"},{"code":"00832712401","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712489","type":"CDM"},{"code":"00832712489","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MINERAL OIL","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00869420610","type":"CDM"},{"code":"00869420610","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOL SWABS 89%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00884629730","type":"CDM"},{"code":"00884629730","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904020261","type":"CDM"},{"code":"00904020261","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.81,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00904078816","type":"CDM"},{"code":"00904078816","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904108761","type":"CDM"},{"code":"00904108761","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904201360","type":"CDM"},{"code":"00904201360","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (37.5 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904213761","type":"CDM"},{"code":"00904213761","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904215161","type":"CDM"},{"code":"00904215161","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904224461","type":"CDM"},{"code":"00904224461","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALAMINE-ZINC OXIDE LOTION","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx00904253321","type":"CDM"},{"code":"00904253321","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMIN CHEW TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904262160","type":"CDM"},{"code":"00904262160","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904292061","type":"CDM"},{"code":"00904292061","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOLIC ACID TAB 400 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904319760","type":"CDM"},{"code":"00904319760","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904322035","type":"CDM"},{"code":"00904322035","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904336561","type":"CDM"},{"code":"00904336561","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SALINE NASAL SPRAY 0.65%","drug_information":{"unit":44.0,"type":"ML"},"code_information":[{"code":"Rx00904386575","type":"CDM"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904399061","type":"CDM"},{"code":"00904399061","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904399161","type":"CDM"},{"code":"00904399161","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904404073","type":"CDM"},{"code":"00904404073","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904418160","type":"CDM"},{"code":"00904418160","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIACIN TAB ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904434260","type":"CDM"},{"code":"00904434260","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904504561","type":"CDM"},{"code":"00904504561","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904505360","type":"CDM"},{"code":"00904505360","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB 250-250-65 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904513559","type":"CDM"},{"code":"00904513559","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904518261","type":"CDM"},{"code":"00904518261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904531360","type":"CDM"},{"code":"00904531360","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.84,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904537961","type":"CDM"},{"code":"00904537961","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904539261","type":"CDM"},{"code":"00904539261","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904549213","type":"CDM"},{"code":"00904549213","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552360","type":"CDM"},{"code":"00904552360","type":"NDC"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552361","type":"CDM"},{"code":"00904552361","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552461","type":"CDM"},{"code":"00904552461","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENALAPRIL MALEATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904561161","type":"CDM"},{"code":"00904561161","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904565661","type":"CDM"},{"code":"00904565661","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904565761","type":"CDM"},{"code":"00904565761","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904571135","type":"CDM"},{"code":"00904571135","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578051","type":"CDM"},{"code":"00904578051","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579361","type":"CDM"},{"code":"00904579361","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579661","type":"CDM"},{"code":"00904579661","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579761","type":"CDM"},{"code":"00904579761","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579861","type":"CDM"},{"code":"00904579861","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904582489","type":"CDM"},{"code":"00904582489","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585861","type":"CDM"},{"code":"00904585861","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589161","type":"CDM"},{"code":"00904589161","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.03,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00904589430","type":"CDM"},{"code":"00904589430","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.77,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592261","type":"CDM"},{"code":"00904592261","type":"NDC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592861","type":"CDM"},{"code":"00904592861","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592961","type":"CDM"},{"code":"00904592961","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904597561","type":"CDM"},{"code":"00904597561","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904597661","type":"CDM"},{"code":"00904597661","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904597761","type":"CDM"},{"code":"00904597761","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904598161","type":"CDM"},{"code":"00904598161","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4.52,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904599461","type":"CDM"},{"code":"00904599461","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904599661","type":"CDM"},{"code":"00904599661","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904606961","type":"CDM"},{"code":"00904606961","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904609061","type":"CDM"},{"code":"00904609061","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904618761","type":"CDM"},{"code":"00904618761","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904619546","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904619546","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904623761","type":"CDM"},{"code":"00904623761","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904623861","type":"CDM"},{"code":"00904623861","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904624261","type":"CDM"},{"code":"00904624261","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904624361","type":"CDM"},{"code":"00904624361","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904624661","type":"CDM"},{"code":"00904624661","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904624961","type":"CDM"},{"code":"00904624961","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904625061","type":"CDM"},{"code":"00904625061","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904625161","type":"CDM"},{"code":"00904625161","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.06,"discounted_cash":9.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904626945","type":"CDM"},{"code":"00904626945","type":"NDC"}],"standard_charges":[{"gross_charge":14.56,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627008","type":"CDM"},{"code":"00904627008","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627045","type":"CDM"},{"code":"00904627045","type":"NDC"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627108","type":"CDM"},{"code":"00904627108","type":"NDC"}],"standard_charges":[{"gross_charge":15.77,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627145","type":"CDM"},{"code":"00904627145","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628061","type":"CDM"},{"code":"00904628061","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628161","type":"CDM"},{"code":"00904628161","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628661","type":"CDM"},{"code":"00904628661","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629006","type":"CDM"},{"code":"00904629006","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629304","type":"CDM"},{"code":"00904629304","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630061","type":"CDM"},{"code":"00904630061","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630361","type":"CDM"},{"code":"00904630361","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.3,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904631061","type":"CDM"},{"code":"00904631061","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROMETHORPHAN POLISTIREX EXTENDED RELEASE SUSP 30 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00904631256","type":"CDM"},{"code":"00904631256","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904631461","type":"CDM"},{"code":"00904631461","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904631561","type":"CDM"},{"code":"00904631561","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632461","type":"CDM"},{"code":"00904632461","type":"NDC"}],"standard_charges":[{"gross_charge":11.44,"discounted_cash":8.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632661","type":"CDM"},{"code":"00904632661","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM (PF) OPHTH SOLN 0.5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632946","type":"CDM"},{"code":"00904632946","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634061","type":"CDM"},{"code":"00904634061","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634161","type":"CDM"},{"code":"00904634161","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634261","type":"CDM"},{"code":"00904634261","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635361","type":"CDM"},{"code":"00904635361","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636061","type":"CDM"},{"code":"00904636061","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636161","type":"CDM"},{"code":"00904636161","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636345","type":"CDM"},{"code":"00904636345","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637161","type":"CDM"},{"code":"00904637161","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637661","type":"CDM"},{"code":"00904637661","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640161","type":"CDM"},{"code":"00904640161","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640561","type":"CDM"},{"code":"00904640561","type":"NDC"}],"standard_charges":[{"gross_charge":12.23,"discounted_cash":8.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MOXIFLOXACIN HCL TAB 400 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640606","type":"CDM"},{"code":"00904640606","type":"NDC"}],"standard_charges":[{"gross_charge":22.36,"discounted_cash":15.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640961","type":"CDM"},{"code":"00904640961","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642161","type":"CDM"},{"code":"00904642161","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642281","type":"CDM"},{"code":"00904642281","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642286","type":"CDM"},{"code":"00904642286","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642304","type":"CDM"},{"code":"00904642304","type":"NDC"}],"standard_charges":[{"gross_charge":20.49,"discounted_cash":14.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642761","type":"CDM"},{"code":"00904642761","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645061","type":"CDM"},{"code":"00904645061","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645561","type":"CDM"},{"code":"00904645561","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":29.24,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19.66,"discounted_cash":13.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647061","type":"CDM"},{"code":"00904647061","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":33.12,"discounted_cash":23.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647561","type":"CDM"},{"code":"00904647561","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647661","type":"CDM"},{"code":"00904647661","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00904648838","type":"CDM"},{"code":"00904648838","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.35,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650106","type":"CDM"},{"code":"00904650106","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650161","type":"CDM"},{"code":"00904650161","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.52,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650606","type":"CDM"},{"code":"00904650606","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20.71,"discounted_cash":14.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651161","type":"CDM"},{"code":"00904651161","type":"NDC"}],"standard_charges":[{"gross_charge":16.96,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MECLIZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651661","type":"CDM"},{"code":"00904651661","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904652261","type":"CDM"},{"code":"00904652261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904652961","type":"CDM"},{"code":"00904652961","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904653806","type":"CDM"},{"code":"00904653806","type":"NDC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904654061","type":"CDM"},{"code":"00904654061","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655461","type":"CDM"},{"code":"00904655461","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655561","type":"CDM"},{"code":"00904655561","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655661","type":"CDM"},{"code":"00904655661","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656507","type":"CDM"},{"code":"00904656507","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.51,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657004","type":"CDM"},{"code":"00904657004","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.73,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657161","type":"CDM"},{"code":"00904657161","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904658261","type":"CDM"},{"code":"00904658261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMIVUDINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904658304","type":"CDM"},{"code":"00904658304","type":"NDC"}],"standard_charges":[{"gross_charge":20.23,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904658561","type":"CDM"},{"code":"00904658561","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904658761","type":"CDM"},{"code":"00904658761","type":"NDC"}],"standard_charges":[{"gross_charge":13.83,"discounted_cash":9.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19.82,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904659304","type":"CDM"},{"code":"00904659304","type":"NDC"}],"standard_charges":[{"gross_charge":22.2,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904659604","type":"CDM"},{"code":"00904659604","type":"NDC"}],"standard_charges":[{"gross_charge":22.3,"discounted_cash":15.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PERPHENAZINE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904660061","type":"CDM"},{"code":"Q0175","type":"HCPCS"},{"code":"00904660061","type":"NDC"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662061","type":"CDM"},{"code":"00904662061","type":"NDC"}],"standard_charges":[{"gross_charge":11.37,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.56,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663061","type":"CDM"},{"code":"00904663061","type":"NDC"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663661","type":"CDM"},{"code":"00904663661","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664161","type":"CDM"},{"code":"00904664161","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664261","type":"CDM"},{"code":"00904664261","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664361","type":"CDM"},{"code":"00904664361","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN CHEW TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664524","type":"CDM"},{"code":"00904664524","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.21,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666404","type":"CDM"},{"code":"00904666404","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904667104","type":"CDM"},{"code":"00904667104","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.13,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17.92,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904668961","type":"CDM"},{"code":"00904668961","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904669161","type":"CDM"},{"code":"00904669161","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670310","type":"CDM"},{"code":"00904670310","type":"NDC"}],"standard_charges":[{"gross_charge":23.15,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670461","type":"CDM"},{"code":"00904670461","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670506","type":"CDM"},{"code":"00904670506","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670561","type":"CDM"},{"code":"00904670561","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670961","type":"CDM"},{"code":"00904670961","type":"NDC"}],"standard_charges":[{"gross_charge":11.56,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904671772","type":"CDM"},{"code":"00904671772","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904672051","type":"CDM"},{"code":"00904672051","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904672559","type":"CDM"},{"code":"00904672559","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904673059","type":"CDM"},{"code":"00904673059","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904673060","type":"CDM"},{"code":"00904673060","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904673080","type":"CDM"},{"code":"00904673080","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904673361","type":"CDM"},{"code":"00904673361","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904674561","type":"CDM"},{"code":"00904674561","type":"NDC"}],"standard_charges":[{"gross_charge":17.32,"discounted_cash":12.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORATADINE ORAL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904676720","type":"CDM"},{"code":"00904676720","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.01,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678061","type":"CDM"},{"code":"00904678061","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678261","type":"CDM"},{"code":"00904678261","type":"NDC"}],"standard_charges":[{"gross_charge":11.56,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 360 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678604","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00904678604","type":"NDC"}],"standard_charges":[{"gross_charge":21.28,"discounted_cash":14.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 360 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678661","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00904678661","type":"NDC"}],"standard_charges":[{"gross_charge":23.68,"discounted_cash":16.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679061","type":"CDM"},{"code":"00904679061","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":20.02,"discounted_cash":14.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679480","type":"CDM"},{"code":"00904679480","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679604","type":"CDM"},{"code":"00904679604","type":"NDC"}],"standard_charges":[{"gross_charge":60.84,"discounted_cash":42.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679610","type":"CDM"},{"code":"00904679610","type":"NDC"}],"standard_charges":[{"gross_charge":26.83,"discounted_cash":18.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904680940","type":"CDM"},{"code":"00904680940","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681004","type":"CDM"},{"code":"00904681004","type":"NDC"}],"standard_charges":[{"gross_charge":13.62,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.97,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682361","type":"CDM"},{"code":"00904682361","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOPERAMIDE HCL SOLN 1 MG/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00904683620","type":"CDM"},{"code":"00904683620","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686161","type":"CDM"},{"code":"00904686161","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686190","type":"CDM"},{"code":"00904686190","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904687204","type":"CDM"},{"code":"00904687204","type":"NDC"}],"standard_charges":[{"gross_charge":13.88,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904688406","type":"CDM"},{"code":"00904688406","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689004","type":"CDM"},{"code":"00904689004","type":"NDC"}],"standard_charges":[{"gross_charge":13.96,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689461","type":"CDM"},{"code":"00904689461","type":"NDC"}],"standard_charges":[{"gross_charge":17.73,"discounted_cash":12.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904690004","type":"CDM"},{"code":"00904690004","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904690204","type":"CDM"},{"code":"00904690204","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.28,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.57,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904691561","type":"CDM"},{"code":"00904691561","type":"NDC"}],"standard_charges":[{"gross_charge":14.24,"discounted_cash":9.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.08,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.94,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.05,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.2,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.49,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAZOSIN HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702161","type":"CDM"},{"code":"00904702161","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17.18,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.08,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALTREXONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904703604","type":"CDM"},{"code":"00904703604","type":"NDC"}],"standard_charges":[{"gross_charge":13.17,"discounted_cash":9.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704206","type":"CDM"},{"code":"00904704206","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.83,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704561","type":"CDM"},{"code":"00904704561","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704661","type":"CDM"},{"code":"00904704661","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":8.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":38.13,"discounted_cash":26.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707007","type":"CDM"},{"code":"00904707007","type":"NDC"}],"standard_charges":[{"gross_charge":14.36,"discounted_cash":10.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":28.1,"discounted_cash":19.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":28.45,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707661","type":"CDM"},{"code":"00904707661","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.7,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708161","type":"CDM"},{"code":"00904708161","type":"NDC"}],"standard_charges":[{"gross_charge":14.12,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708404","type":"CDM"},{"code":"00904708404","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.36,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708861","type":"CDM"},{"code":"00904708861","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.11,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710661","type":"CDM"},{"code":"00904710661","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710761","type":"CDM"},{"code":"00904710761","type":"NDC"}],"standard_charges":[{"gross_charge":14.93,"discounted_cash":10.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710961","type":"CDM"},{"code":"00904710961","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711061","type":"CDM"},{"code":"00904711061","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.3,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712361","type":"CDM"},{"code":"00904712361","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712804","type":"CDM"},{"code":"00904712804","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904713161","type":"CDM"},{"code":"00904713161","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.26,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.02,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718261","type":"CDM"},{"code":"00904718261","type":"NDC"}],"standard_charges":[{"gross_charge":13.36,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718561","type":"CDM"},{"code":"00904718561","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719461","type":"CDM"},{"code":"00904719461","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.05,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904720061","type":"CDM"},{"code":"00904720061","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904720660","type":"CDM"},{"code":"00904720660","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.75,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721104","type":"CDM"},{"code":"00904721104","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721461","type":"CDM"},{"code":"00904721461","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXCARBAZEPINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726361","type":"CDM"},{"code":"00904726361","type":"NDC"}],"standard_charges":[{"gross_charge":11.52,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904726541","type":"CDM"},{"code":"00904726541","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.75,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904728861","type":"CDM"},{"code":"00904728861","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.24,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.93,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACITRACIN OINT 500 UNIT/GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904740267","type":"CDM"},{"code":"00904740267","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM CITRATE SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"Rx00904741844","type":"CDM"},{"code":"00904741844","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.75,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACOSAMIDE ORAL SOLUTION 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904746464","type":"CDM"},{"code":"00904746464","type":"NDC"}],"standard_charges":[{"gross_charge":52.33,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACOSAMIDE ORAL SOLUTION 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904746466","type":"CDM"},{"code":"00904746466","type":"NDC"}],"standard_charges":[{"gross_charge":51.78,"discounted_cash":36.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750604","type":"CDM"},{"code":"00904750604","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904751241","type":"CDM"},{"code":"00904751241","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904752713","type":"CDM"},{"code":"00904752713","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4.5,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904791559","type":"CDM"},{"code":"00904791559","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BISACODYL TAB DELAYED RELEASE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904792761","type":"CDM"},{"code":"00904792761","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904880567","type":"CDM"},{"code":"00904880567","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETHYL ESTERS OF IODIZED FATTY ACIDS INJECTION","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00930621608","type":"CDM"},{"code":"00930621608","type":"NDC"}],"standard_charges":[{"gross_charge":1414.54,"discounted_cash":990.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PERITONEAL DIALYSIS SOLUTIONS 346 MOSM/L","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00941042653","type":"CDM"},{"code":"00941042653","type":"NDC"}],"standard_charges":[{"gross_charge":202.49,"discounted_cash":141.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PERITONEAL DIALYSIS SOLUTIONS 346 MOSM/L","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00941042655","type":"CDM"},{"code":"00941042655","type":"NDC"}],"standard_charges":[{"gross_charge":197.93,"discounted_cash":138.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ANTICOAGULANT CITRATE DEXTROSE SOLUTION A","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00942064104","type":"CDM"},{"code":"00942064104","type":"NDC"}],"standard_charges":[{"gross_charge":115.59,"discounted_cash":80.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":491.31,"discounted_cash":343.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":491.31,"discounted_cash":343.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":492.9,"discounted_cash":345.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":480.97,"discounted_cash":336.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1461.66,"discounted_cash":1023.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2923.32,"discounted_cash":2046.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5846.64,"discounted_cash":4092.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8769.96,"discounted_cash":6138.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":8776.08,"discounted_cash":6143.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ 1000 MG/50ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944288401","type":"CDM"},{"code":"J0257","type":"HCPCS"},{"code":"00944288401","type":"NDC"}],"standard_charges":[{"gross_charge":1462.59,"discounted_cash":1023.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ 1000 MG/50ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944288402","type":"CDM"},{"code":"J0257","type":"HCPCS"},{"code":"00944288402","type":"NDC"}],"standard_charges":[{"gross_charge":1462.59,"discounted_cash":1023.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944305202","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00944305202","type":"NDC"}],"standard_charges":[{"gross_charge":2247.91,"discounted_cash":1573.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944305302","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00944305302","type":"NDC"}],"standard_charges":[{"gross_charge":4548.3,"discounted_cash":3183.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FIBRIN SEALANT COMPONENT KIT 4 ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944420108","type":"CDM"},{"code":"00944420108","type":"NDC"}],"standard_charges":[{"gross_charge":470.36,"discounted_cash":329.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FIBRIN SEALANT COMPONENT KIT 10 ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944420111","type":"CDM"},{"code":"00944420111","type":"NDC"}],"standard_charges":[{"gross_charge":1113.15,"discounted_cash":779.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FIBRIN SEALANT COMPONENT KIT 10 ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944420112","type":"CDM"},{"code":"00944420112","type":"NDC"}],"standard_charges":[{"gross_charge":1157.68,"discounted_cash":810.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00955100410","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100410","type":"NDC"}],"standard_charges":[{"gross_charge":126.26,"discounted_cash":88.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00955100610","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100610","type":"NDC"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00955100810","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100810","type":"NDC"}],"standard_charges":[{"gross_charge":221.15,"discounted_cash":154.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00955101210","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101210","type":"NDC"}],"standard_charges":[{"gross_charge":347.52,"discounted_cash":243.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ 300 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00955101601","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101601","type":"NDC"}],"standard_charges":[{"gross_charge":935.25,"discounted_cash":654.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00955102001","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00955102001","type":"NDC"}],"standard_charges":[{"gross_charge":530.48,"discounted_cash":371.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105027","type":"CDM"},{"code":"00955105027","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105201","type":"CDM"},{"code":"00955105201","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":18.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105290","type":"CDM"},{"code":"00955105290","type":"NDC"}],"standard_charges":[{"gross_charge":26.56,"discounted_cash":18.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 40 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00990707726","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990707726","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00990710909","type":"CDM"},{"code":"00990710909","type":"NDC"}],"standard_charges":[{"gross_charge":159.79,"discounted_cash":111.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN D5W LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00990711109","type":"CDM"},{"code":"00990711109","type":"NDC"}],"standard_charges":[{"gross_charge":165.64,"discounted_cash":115.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":147.96,"discounted_cash":103.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00990793519","type":"CDM"},{"code":"00990793519","type":"NDC"}],"standard_charges":[{"gross_charge":172.46,"discounted_cash":120.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00990793619","type":"CDM"},{"code":"00990793619","type":"NDC"}],"standard_charges":[{"gross_charge":145.89,"discounted_cash":102.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00990798361","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00990798361","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998001615","type":"CDM"},{"code":"00998001615","type":"NDC"}],"standard_charges":[{"gross_charge":127.99,"discounted_cash":89.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020315","type":"CDM"},{"code":"00998020315","type":"NDC"}],"standard_charges":[{"gross_charge":298.06,"discounted_cash":208.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020415","type":"CDM"},{"code":"00998020415","type":"NDC"}],"standard_charges":[{"gross_charge":303.72,"discounted_cash":212.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020615","type":"CDM"},{"code":"00998020615","type":"NDC"}],"standard_charges":[{"gross_charge":315.82,"discounted_cash":221.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998035515","type":"CDM"},{"code":"00998035515","type":"NDC"}],"standard_charges":[{"gross_charge":331.33,"discounted_cash":231.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 262 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx01490003908","type":"CDM"},{"code":"01490003908","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx06275675560","type":"CDM"},{"code":"6275675560","type":"NDC"}],"standard_charges":[{"gross_charge":15.94,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP DELAYED RELEASE 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx07610017120","type":"CDM"},{"code":"07610017120","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":964.01,"discounted_cash":674.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1063.23,"discounted_cash":744.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NA CHONDROIT SULF-NA HYALURON PREF SYR 20-15 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx08065183905","type":"CDM"},{"code":"08065183905","type":"NDC"}],"standard_charges":[{"gross_charge":980.23,"discounted_cash":686.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 10 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx08290306413","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"08290306413","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx08489800001","type":"CDM"},{"code":"08489800001","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 5.5 MG/0.55ML","drug_information":{"unit":0.55,"type":"ML"},"code_information":[{"code":"Rx08544636971","type":"CDM"},{"code":"08544636971","type":"NDC"}],"standard_charges":[{"gross_charge":690.05,"discounted_cash":483.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 8.5 MG/0.85ML","drug_information":{"unit":0.85,"type":"ML"},"code_information":[{"code":"Rx08544636981","type":"CDM"},{"code":"08544636981","type":"NDC"}],"standard_charges":[{"gross_charge":1057.67,"discounted_cash":740.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx08880950550","type":"CDM"},{"code":"08880950550","type":"NDC"}],"standard_charges":[{"gross_charge":59.56,"discounted_cash":41.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070031","type":"CDM"},{"code":"10006070031","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070033","type":"CDM"},{"code":"10006070033","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070038","type":"CDM"},{"code":"10006070038","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006073021","type":"CDM"},{"code":"10006073021","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":779.21,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx10019007587","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"10019007587","type":"NDC"}],"standard_charges":[{"gross_charge":706.69,"discounted_cash":494.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx10019012039","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"10019012039","type":"NDC"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":125.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019055303","type":"CDM"},{"code":"10019055303","type":"NDC"}],"standard_charges":[{"gross_charge":31.94,"discounted_cash":22.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":31.94,"discounted_cash":22.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40.06,"discounted_cash":28.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":519.83,"discounted_cash":363.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":410.9,"discounted_cash":287.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1236.44,"discounted_cash":865.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092616","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092616","type":"NDC"}],"standard_charges":[{"gross_charge":988.52,"discounted_cash":691.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":353.65,"discounted_cash":247.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019095601","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019095601","type":"NDC"}],"standard_charges":[{"gross_charge":1704.66,"discounted_cash":1193.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2236.2,"discounted_cash":1565.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4352.05,"discounted_cash":3046.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLEVIDIPINE IV EMULSION 25 MG/50ML,CLEVIDIPINE IV EMULSION 50 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx10122061001","type":"CDM"},{"code":"J0759","type":"HCPCS"},{"code":"10122061001","type":"NDC"}],"standard_charges":[{"gross_charge":1109.02,"discounted_cash":776.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLEVIDIPINE IV EMULSION 25 MG/50ML,CLEVIDIPINE IV EMULSION 50 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx10122061010","type":"CDM"},{"code":"J0759","type":"HCPCS"},{"code":"10122061010","type":"NDC"}],"standard_charges":[{"gross_charge":1024.05,"discounted_cash":716.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2845.99,"discounted_cash":1992.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3737.95,"discounted_cash":2616.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10135012001","type":"CDM"},{"code":"10135012001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10135013201","type":"CDM"},{"code":"10135013201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10139090502","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"10139090502","type":"NDC"}],"standard_charges":[{"gross_charge":931.21,"discounted_cash":651.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ITRACONAZOLE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx10147015001","type":"CDM"},{"code":"10147015001","type":"NDC"}],"standard_charges":[{"gross_charge":43.64,"discounted_cash":30.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx10147092103","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"10147092103","type":"NDC"}],"standard_charges":[{"gross_charge":382.82,"discounted_cash":267.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10157210303","type":"CDM"},{"code":"10157210303","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUTAMBEN-TETRACAINE-BENZOCAINE AEROSOL SPRAY 2-2-14%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx10223020104","type":"CDM"},{"code":"10223020104","type":"NDC"}],"standard_charges":[{"gross_charge":212.31,"discounted_cash":148.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GUANFACINE HCL TAB ER 24HR 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10370053301","type":"CDM"},{"code":"10370053301","type":"NDC"}],"standard_charges":[{"gross_charge":11.27,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEXAMINOLEVULINATE HCL FOR SOLN 100 MG (85 MG BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10511300102","type":"CDM"},{"code":"A9589","type":"HCPCS"},{"code":"10511300102","type":"NDC"}],"standard_charges":[{"gross_charge":4516.56,"discounted_cash":3161.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MOMETASONE FUROATE SINUS IMPLANT 1350 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10599000301","type":"CDM"},{"code":"J7402","type":"HCPCS"},{"code":"10599000301","type":"NDC"}],"standard_charges":[{"gross_charge":2576.41,"discounted_cash":1803.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":233.54,"discounted_cash":163.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROAMPHETAMINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702006503","type":"CDM"},{"code":"10702006503","type":"NDC"}],"standard_charges":[{"gross_charge":13.95,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11523723401","type":"CDM"},{"code":"11523723401","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11523726808","type":"CDM"},{"code":"11523726808","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx11701003816","type":"CDM"},{"code":"11701003816","type":"NDC"}],"standard_charges":[{"gross_charge":7.99,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM CIT-VITAMIN D TAB 315 MG-5 MCG(200 UNIT) (ELEM CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11845012375","type":"CDM"},{"code":"11845012375","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFACETAMIDE SODIUM OPHTH SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980001105","type":"CDM"},{"code":"11980001105","type":"NDC"}],"standard_charges":[{"gross_charge":391.13,"discounted_cash":273.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980018005","type":"CDM"},{"code":"11980018005","type":"NDC"}],"standard_charges":[{"gross_charge":393.64,"discounted_cash":275.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOROMETHOLONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980021105","type":"CDM"},{"code":"11980021105","type":"NDC"}],"standard_charges":[{"gross_charge":495.21,"discounted_cash":346.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980077905","type":"CDM"},{"code":"11980077905","type":"NDC"}],"standard_charges":[{"gross_charge":378.09,"discounted_cash":264.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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: WSH LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12165010001","type":"CDM"},{"code":"12165010001","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12165010003","type":"CDM"},{"code":"12165010003","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546000157","type":"CDM"},{"code":"12546000157","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546062542","type":"CDM"},{"code":"12546062542","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THROAT LOZENGES - LOZENGES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546062936","type":"CDM"},{"code":"12546062936","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12547017031","type":"CDM"},{"code":"12547017031","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.3,"type":"GM"},"code_information":[{"code":"Rx12547017167","type":"CDM"},{"code":"12547017167","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12843013231","type":"CDM"},{"code":"12843013231","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12843053637","type":"CDM"},{"code":"12843053637","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.25,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13107003105","type":"CDM"},{"code":"13107003105","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1819.76,"discounted_cash":1273.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1253.3,"discounted_cash":877.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1833.26,"discounted_cash":1283.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ANTITHROMBIN III (HUMAN) FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533060320","type":"CDM"},{"code":"J7197","type":"HCPCS"},{"code":"13533060320","type":"NDC"}],"standard_charges":[{"gross_charge":6649.62,"discounted_cash":4654.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1176.6,"discounted_cash":823.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2131.96,"discounted_cash":1492.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":998.32,"discounted_cash":698.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":383.26,"discounted_cash":268.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":365.01,"discounted_cash":255.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx13533068420","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"13533068420","type":"NDC"}],"standard_charges":[{"gross_charge":732.99,"discounted_cash":513.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ 1000 MG/20ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533070501","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"13533070501","type":"NDC"}],"standard_charges":[{"gross_charge":1958.4,"discounted_cash":1370.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ 1000 MG/20ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533070511","type":"CDM"},{"code":"J0256","type":"HCPCS"},{"code":"13533070511","type":"NDC"}],"standard_charges":[{"gross_charge":1958.4,"discounted_cash":1370.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1327.83,"discounted_cash":929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5311.34,"discounted_cash":3717.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10622.68,"discounted_cash":7435.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2655.67,"discounted_cash":1858.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668007930","type":"CDM"},{"code":"13668007930","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668059380","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"13668059380","type":"NDC"}],"standard_charges":[{"gross_charge":400.66,"discounted_cash":280.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"APREPITANT CAPSULE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668059386","type":"CDM"},{"code":"J8501","type":"HCPCS"},{"code":"13668059386","type":"NDC"}],"standard_charges":[{"gross_charge":328.51,"discounted_cash":229.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.32,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668072090","type":"CDM"},{"code":"13668072090","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811051510","type":"CDM"},{"code":"13811051510","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811067930","type":"CDM"},{"code":"13811067930","type":"NDC"}],"standard_charges":[{"gross_charge":24.67,"discounted_cash":17.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811068130","type":"CDM"},{"code":"13811068130","type":"NDC"}],"standard_charges":[{"gross_charge":24.67,"discounted_cash":17.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 36 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811070810","type":"CDM"},{"code":"13811070810","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811071910","type":"CDM"},{"code":"13811071910","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13925051510","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"13925051510","type":"NDC"}],"standard_charges":[{"gross_charge":1264.6,"discounted_cash":885.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR NEBULIZATION SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13925052201","type":"CDM"},{"code":"J2545","type":"HCPCS"},{"code":"13925052201","type":"NDC"}],"standard_charges":[{"gross_charge":121.94,"discounted_cash":85.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx14539067401","type":"CDM"},{"code":"14539067401","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx14539067505","type":"CDM"},{"code":"Q0177","type":"HCPCS"},{"code":"14539067505","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789001101","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789001101","type":"NDC"}],"standard_charges":[{"gross_charge":1253.65,"discounted_cash":877.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789001107","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789001107","type":"NDC"}],"standard_charges":[{"gross_charge":1605.99,"discounted_cash":1124.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1020.14,"discounted_cash":714.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":495.3,"discounted_cash":346.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":822.18,"discounted_cash":575.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1077.7,"discounted_cash":754.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789012105","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"14789012105","type":"NDC"}],"standard_charges":[{"gross_charge":116.62,"discounted_cash":81.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789022008","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"14789022008","type":"NDC"}],"standard_charges":[{"gross_charge":200.59,"discounted_cash":140.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx14789070002","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"14789070002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx14789070007","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"14789070007","type":"NDC"}],"standard_charges":[{"gross_charge":176.87,"discounted_cash":123.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12029.45,"discounted_cash":8420.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ABOBOTULINUMTOXINA FOR IM INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx15054050001","type":"CDM"},{"code":"J0586","type":"HCPCS"},{"code":"15054050001","type":"NDC"}],"standard_charges":[{"gross_charge":2609.4,"discounted_cash":1826.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ABOBOTULINUMTOXINA FOR IM INJ 300 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx15054053006","type":"CDM"},{"code":"J0586","type":"HCPCS"},{"code":"15054053006","type":"NDC"}],"standard_charges":[{"gross_charge":1566.23,"discounted_cash":1096.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LANREOTIDE ACETATE EXTENDED RELEASE INJ 60 MG/0.2ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx15054106004","type":"CDM"},{"code":"J1930","type":"HCPCS"},{"code":"15054106004","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40368.66,"discounted_cash":28258.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16103036611","type":"CDM"},{"code":"16103036611","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISRADIPINE CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16252054001","type":"CDM"},{"code":"16252054001","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16252059299","type":"CDM"},{"code":"16252059299","type":"NDC"}],"standard_charges":[{"gross_charge":13.22,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx16571012025","type":"CDM"},{"code":"16571012025","type":"NDC"}],"standard_charges":[{"gross_charge":74.33,"discounted_cash":52.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16571014050","type":"CDM"},{"code":"16571014050","type":"NDC"}],"standard_charges":[{"gross_charge":55.06,"discounted_cash":38.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16571014150","type":"CDM"},{"code":"16571014150","type":"NDC"}],"standard_charges":[{"gross_charge":58.72,"discounted_cash":41.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571024603","type":"CDM"},{"code":"16571024603","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571024616","type":"CDM"},{"code":"16571024616","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL ELIXIR 20 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx16571033016","type":"CDM"},{"code":"16571033016","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL ELIXIR 20 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx16571067516","type":"CDM"},{"code":"16571067516","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.97,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":32.54,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729004101","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"16729004101","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729004201","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"16729004201","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729004301","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"16729004301","type":"NDC"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAPECITABINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729007329","type":"CDM"},{"code":"J8522","type":"HCPCS"},{"code":"16729007329","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009001","type":"CDM"},{"code":"16729009001","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009010","type":"CDM"},{"code":"16729009010","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009015","type":"CDM"},{"code":"16729009015","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729010811","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729010811","type":"NDC"}],"standard_charges":[{"gross_charge":1432.69,"discounted_cash":1002.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":902.5,"discounted_cash":631.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729013501","type":"CDM"},{"code":"16729013501","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPOTECAN HCL FOR INJ 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729015131","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"16729015131","type":"NDC"}],"standard_charges":[{"gross_charge":526.62,"discounted_cash":368.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 360 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729018929","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"16729018929","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729021301","type":"CDM"},{"code":"16729021301","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729023930","type":"CDM"},{"code":"16729023930","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729023993","type":"CDM"},{"code":"16729023993","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729026763","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"16729026763","type":"NDC"}],"standard_charges":[{"gross_charge":381.89,"discounted_cash":267.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx16729026764","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"16729026764","type":"NDC"}],"standard_charges":[{"gross_charge":1055.11,"discounted_cash":738.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729027503","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"16729027503","type":"NDC"}],"standard_charges":[{"gross_charge":1154.48,"discounted_cash":808.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729027567","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"16729027567","type":"NDC"}],"standard_charges":[{"gross_charge":644.29,"discounted_cash":451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx16729027638","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"16729027638","type":"NDC"}],"standard_charges":[{"gross_charge":840.93,"discounted_cash":588.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx16729027668","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"16729027668","type":"NDC"}],"standard_charges":[{"gross_charge":194.72,"discounted_cash":136.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx16729027735","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"16729027735","type":"NDC"}],"standard_charges":[{"gross_charge":293.17,"discounted_cash":205.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx16729028811","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"16729028811","type":"NDC"}],"standard_charges":[{"gross_charge":185.16,"discounted_cash":129.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729029730","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"16729029730","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729029783","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"16729029783","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":468.45,"discounted_cash":327.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx16729033203","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"16729033203","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.2,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729043315","type":"CDM"},{"code":"16729043315","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729043630","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"16729043630","type":"NDC"}],"standard_charges":[{"gross_charge":598.06,"discounted_cash":418.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729044815","type":"CDM"},{"code":"16729044815","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729045215","type":"CDM"},{"code":"16729045215","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729047901","type":"CDM"},{"code":"16729047901","type":"NDC"}],"standard_charges":[{"gross_charge":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx16729049303","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"16729049303","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx16729049345","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"16729049345","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx16729052508","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"16729052508","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEHYDRATED ALCOHOL INTRA-ARTERIAL SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729071031","type":"CDM"},{"code":"16729071031","type":"NDC"}],"standard_charges":[{"gross_charge":1654.29,"discounted_cash":1158.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEHYDRATED ALCOHOL INTRA-ARTERIAL SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729071045","type":"CDM"},{"code":"16729071045","type":"NDC"}],"standard_charges":[{"gross_charge":1112.06,"discounted_cash":778.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZOCAINE-MENTHOL AEROSOL 20-0.5%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx16864068003","type":"CDM"},{"code":"16864068003","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IOBENGUANE SULFATE I 123 IV SOLN 10 MCI/5ML (2 MCI/ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17156023501","type":"CDM"},{"code":"A9582","type":"HCPCS"},{"code":"17156023501","type":"NDC"}],"standard_charges":[{"gross_charge":4000.0,"discounted_cash":2800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTETATE INDIUM DISODIUM IN 111 INTRATHECAL INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17156025108","type":"CDM"},{"code":"A9548","type":"HCPCS"},{"code":"17156025108","type":"NDC"}],"standard_charges":[{"gross_charge":7478.76,"discounted_cash":5235.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SPECIALITY VITAMIN PRODUCT TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17204043440","type":"CDM"},{"code":"17204043440","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx17271072006","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"17271072006","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx17478003005","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"17478003005","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478004001","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"17478004001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx17478004101","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"17478004101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":553.92,"discounted_cash":387.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 100 MCG/2ML (50 MCG/ML)","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx17478005002","type":"CDM"},{"code":"17478005002","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 250 MCG/5ML (50 MCG/ML)","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx17478005005","type":"CDM"},{"code":"17478005005","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALFENTANIL HCL IV SOLN 1000 MCG/2ML (500 MCG/ML) (BASE EQ),ALFENTANIL HCL IV SOLN 2500 MCG/5ML (500 MCG/ML) (BASE EQ)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478006702","type":"CDM"},{"code":"J0216","type":"HCPCS"},{"code":"17478006702","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478010212","type":"CDM"},{"code":"17478010212","type":"NDC"}],"standard_charges":[{"gross_charge":72.95,"discounted_cash":51.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIFAMPIN FOR INJ 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478015142","type":"CDM"},{"code":"J2804","type":"HCPCS"},{"code":"17478015142","type":"NDC"}],"standard_charges":[{"gross_charge":1186.93,"discounted_cash":830.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478017101","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"17478017101","type":"NDC"}],"standard_charges":[{"gross_charge":14.81,"discounted_cash":10.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478017130","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"17478017130","type":"NDC"}],"standard_charges":[{"gross_charge":21.83,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478020910","type":"CDM"},{"code":"17478020910","type":"NDC"}],"standard_charges":[{"gross_charge":135.68,"discounted_cash":94.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx17478020919","type":"CDM"},{"code":"17478020919","type":"NDC"}],"standard_charges":[{"gross_charge":89.39,"discounted_cash":62.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478025310","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"17478025310","type":"NDC"}],"standard_charges":[{"gross_charge":1091.69,"discounted_cash":764.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478026312","type":"CDM"},{"code":"17478026312","type":"NDC"}],"standard_charges":[{"gross_charge":142.93,"discounted_cash":100.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478028810","type":"CDM"},{"code":"17478028810","type":"NDC"}],"standard_charges":[{"gross_charge":69.18,"discounted_cash":48.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478029010","type":"CDM"},{"code":"17478029010","type":"NDC"}],"standard_charges":[{"gross_charge":81.47,"discounted_cash":57.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478041940","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"17478041940","type":"NDC"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":828.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478042240","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"17478042240","type":"NDC"}],"standard_charges":[{"gross_charge":1079.53,"discounted_cash":755.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHYSOSTIGMINE SALICYLATE INJ 1 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx17478051002","type":"CDM"},{"code":"17478051002","type":"NDC"}],"standard_charges":[{"gross_charge":285.51,"discounted_cash":199.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIMERCAPROL INJ 100 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx17478052603","type":"CDM"},{"code":"J0470","type":"HCPCS"},{"code":"17478052603","type":"NDC"}],"standard_charges":[{"gross_charge":2008.11,"discounted_cash":1405.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478054001","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"17478054001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx17478054050","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"17478054050","type":"NDC"}],"standard_charges":[{"gross_charge":1173.74,"discounted_cash":821.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GRANISETRON HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478054602","type":"CDM"},{"code":"J1626","type":"HCPCS"},{"code":"17478054602","type":"NDC"}],"standard_charges":[{"gross_charge":275.22,"discounted_cash":192.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx17478060510","type":"CDM"},{"code":"17478060510","type":"NDC"}],"standard_charges":[{"gross_charge":608.23,"discounted_cash":425.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE HYPERTONIC OPHTH OINT 5%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx17478062235","type":"CDM"},{"code":"17478062235","type":"NDC"}],"standard_charges":[{"gross_charge":13.61,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx17478062512","type":"CDM"},{"code":"17478062512","type":"NDC"}],"standard_charges":[{"gross_charge":91.87,"discounted_cash":64.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx17478070311","type":"CDM"},{"code":"17478070311","type":"NDC"}],"standard_charges":[{"gross_charge":77.7,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071310","type":"CDM"},{"code":"17478071310","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":66.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx17478071311","type":"CDM"},{"code":"17478071311","type":"NDC"}],"standard_charges":[{"gross_charge":135.85,"discounted_cash":95.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":103.94,"discounted_cash":72.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478093401","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"17478093401","type":"NDC"}],"standard_charges":[{"gross_charge":558.21,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":159.39,"discounted_cash":111.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYALURONIDASE HUMAN INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx18657011701","type":"CDM"},{"code":"J3473","type":"HCPCS"},{"code":"18657011701","type":"NDC"}],"standard_charges":[{"gross_charge":575.46,"discounted_cash":402.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYALURONIDASE HUMAN INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx18657011702","type":"CDM"},{"code":"J3473","type":"HCPCS"},{"code":"18657011702","type":"NDC"}],"standard_charges":[{"gross_charge":588.9,"discounted_cash":412.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYALURONIDASE HUMAN INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx18657011704","type":"CDM"},{"code":"J3473","type":"HCPCS"},{"code":"18657011704","type":"NDC"}],"standard_charges":[{"gross_charge":586.15,"discounted_cash":410.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555000600","type":"CDM"},{"code":"20555000600","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE TAB 325 MG (65 MG ELEMENTAL FE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555002101","type":"CDM"},{"code":"20555002101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx21130077782","type":"CDM"},{"code":"21130077782","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BIOTIN 10000 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx21245023262","type":"CDM"},{"code":"21245023262","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE SOLN 1%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx21922000221","type":"CDM"},{"code":"21922000221","type":"NDC"}],"standard_charges":[{"gross_charge":82.19,"discounted_cash":57.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx21922001604","type":"CDM"},{"code":"21922001604","type":"NDC"}],"standard_charges":[{"gross_charge":63.62,"discounted_cash":44.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx21922001704","type":"CDM"},{"code":"21922001704","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":44.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":103.53,"discounted_cash":72.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx21922003104","type":"CDM"},{"code":"21922003104","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":44.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx21922006230","type":"CDM"},{"code":"21922006230","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":67.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155000101","type":"CDM"},{"code":"23155000101","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155001001","type":"CDM"},{"code":"23155001001","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETRACYCLINE HCL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155001701","type":"CDM"},{"code":"23155001701","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155004303","type":"CDM"},{"code":"23155004303","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155006501","type":"CDM"},{"code":"23155006501","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010201","type":"CDM"},{"code":"23155010201","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEPROBAMATE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155012901","type":"CDM"},{"code":"23155012901","type":"NDC"}],"standard_charges":[{"gross_charge":23.08,"discounted_cash":16.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155016631","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"23155016631","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155016641","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"23155016641","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIDOFOVIR IV INJ 75 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx23155021631","type":"CDM"},{"code":"J0740","type":"HCPCS"},{"code":"23155021631","type":"NDC"}],"standard_charges":[{"gross_charge":2335.06,"discounted_cash":1634.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155024031","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"23155024031","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155024901","type":"CDM"},{"code":"23155024901","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARMUSTINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155026141","type":"CDM"},{"code":"J9050","type":"HCPCS"},{"code":"23155026141","type":"NDC"}],"standard_charges":[{"gross_charge":5507.33,"discounted_cash":3855.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155028801","type":"CDM"},{"code":"23155028801","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":427.39,"discounted_cash":299.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155034531","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"23155034531","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx23155034532","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"23155034532","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155047332","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"23155047332","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155047342","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155049731","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155049731","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.19,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.2,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155066043","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"23155066043","type":"NDC"}],"standard_charges":[{"gross_charge":778.65,"discounted_cash":545.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCITRIOL CAP 0.5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155066301","type":"CDM"},{"code":"23155066301","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155068731","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"23155068731","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155068741","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"23155068741","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155074831","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"23155074831","type":"NDC"}],"standard_charges":[{"gross_charge":1170.91,"discounted_cash":819.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155074841","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"23155074841","type":"NDC"}],"standard_charges":[{"gross_charge":1125.18,"discounted_cash":787.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155078531","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155078531","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.47,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155090431","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"23155090431","type":"NDC"}],"standard_charges":[{"gross_charge":565.35,"discounted_cash":395.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6.1,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx24201010001","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"24201010001","type":"NDC"}],"standard_charges":[{"gross_charge":113.68,"discounted_cash":79.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx24201010024","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"24201010024","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208029005","type":"CDM"},{"code":"24208029005","type":"NDC"}],"standard_charges":[{"gross_charge":82.63,"discounted_cash":57.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx24208029525","type":"CDM"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":185.93,"discounted_cash":130.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208031510","type":"CDM"},{"code":"24208031510","type":"NDC"}],"standard_charges":[{"gross_charge":79.29,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE HYPERTONIC OPHTH OINT 5%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208038555","type":"CDM"},{"code":"24208038555","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx24208039830","type":"CDM"},{"code":"24208039830","type":"NDC"}],"standard_charges":[{"gross_charge":147.17,"discounted_cash":103.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":90.17,"discounted_cash":63.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208041115","type":"CDM"},{"code":"24208041115","type":"NDC"}],"standard_charges":[{"gross_charge":170.19,"discounted_cash":119.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":105.23,"discounted_cash":73.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx24208046325","type":"CDM"},{"code":"24208046325","type":"NDC"}],"standard_charges":[{"gross_charge":99.73,"discounted_cash":69.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":141.52,"discounted_cash":99.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208048610","type":"CDM"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"gross_charge":75.22,"discounted_cash":52.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":157.88,"discounted_cash":110.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":111.23,"discounted_cash":77.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":146.13,"discounted_cash":102.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24208058559","type":"CDM"},{"code":"24208058559","type":"NDC"}],"standard_charges":[{"gross_charge":71.94,"discounted_cash":50.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208058564","type":"CDM"},{"code":"24208058564","type":"NDC"}],"standard_charges":[{"gross_charge":130.88,"discounted_cash":91.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":178.5,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208067615","type":"CDM"},{"code":"24208067615","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":65.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208068615","type":"CDM"},{"code":"24208068615","type":"NDC"}],"standard_charges":[{"gross_charge":107.03,"discounted_cash":74.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":176.28,"discounted_cash":123.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.45,"discounted_cash":101.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24208073501","type":"CDM"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":83.61,"discounted_cash":58.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":185.21,"discounted_cash":129.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":88.36,"discounted_cash":61.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH GEL FORMING SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208081605","type":"CDM"},{"code":"24208081605","type":"NDC"}],"standard_charges":[{"gross_charge":752.72,"discounted_cash":526.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH GEL FORMING SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208081905","type":"CDM"},{"code":"24208081905","type":"NDC"}],"standard_charges":[{"gross_charge":529.54,"discounted_cash":370.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208083060","type":"CDM"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":92.45,"discounted_cash":64.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":71.6,"discounted_cash":50.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZALKONIUM CHLORIDE-ALCOHOL TINCTURE 0.13-50%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx24286015341","type":"CDM"},{"code":"24286015341","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":24.15,"discounted_cash":16.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24338013013","type":"CDM"},{"code":"24338013013","type":"NDC"}],"standard_charges":[{"gross_charge":46.92,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIMODIPINE ORAL SOLN 6 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24338026010","type":"CDM"},{"code":"24338026010","type":"NDC"}],"standard_charges":[{"gross_charge":85.69,"discounted_cash":59.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIMODIPINE ORAL SOLN 6 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24338026012","type":"CDM"},{"code":"24338026012","type":"NDC"}],"standard_charges":[{"gross_charge":85.69,"discounted_cash":59.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENDAMUSTINE HCL IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx24338027001","type":"CDM"},{"code":"J9056","type":"HCPCS"},{"code":"24338027001","type":"NDC"}],"standard_charges":[{"gross_charge":12899.14,"discounted_cash":9029.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALUM (POTASSIUM) POWDER","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx24357030001","type":"CDM"},{"code":"24357030001","type":"NDC"}],"standard_charges":[{"gross_charge":1166.26,"discounted_cash":816.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.54,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.54,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K 2 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571010205","type":"CDM"},{"code":"24571010205","type":"NDC"}],"standard_charges":[{"gross_charge":196.02,"discounted_cash":137.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K-CA 2-3.5 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571010305","type":"CDM"},{"code":"24571010305","type":"NDC"}],"standard_charges":[{"gross_charge":251.44,"discounted_cash":176.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K-CA 4-2.5 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571010505","type":"CDM"},{"code":"24571010505","type":"NDC"}],"standard_charges":[{"gross_charge":196.02,"discounted_cash":137.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K-CA 4-2.5 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571010506","type":"CDM"},{"code":"24571010506","type":"NDC"}],"standard_charges":[{"gross_charge":192.94,"discounted_cash":135.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICARB 22 MEQ/L-DEXT SOLN WITH K 4 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571011105","type":"CDM"},{"code":"24571011105","type":"NDC"}],"standard_charges":[{"gross_charge":202.69,"discounted_cash":141.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K-MG 4-1.2 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571011405","type":"CDM"},{"code":"24571011405","type":"NDC"}],"standard_charges":[{"gross_charge":192.94,"discounted_cash":135.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K-MG 4-1.2 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571011406","type":"CDM"},{"code":"24571011406","type":"NDC"}],"standard_charges":[{"gross_charge":192.94,"discounted_cash":135.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979001001","type":"CDM"},{"code":"24979001001","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GUANFACINE HCL TAB ER 24HR 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979053301","type":"CDM"},{"code":"24979053301","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GUANFACINE HCL TAB ER 24HR 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979053801","type":"CDM"},{"code":"24979053801","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010020515","type":"CDM"},{"code":"25010020515","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010021027","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"25010021027","type":"NDC"}],"standard_charges":[{"gross_charge":18757.55,"discounted_cash":13130.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010021515","type":"CDM"},{"code":"25010021515","type":"NDC"}],"standard_charges":[{"gross_charge":52.01,"discounted_cash":36.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBIDOPA TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010071115","type":"CDM"},{"code":"25010071115","type":"NDC"}],"standard_charges":[{"gross_charge":60.82,"discounted_cash":42.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH GEL FORMING SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25010081756","type":"CDM"},{"code":"25010081756","type":"NDC"}],"standard_charges":[{"gross_charge":357.03,"discounted_cash":249.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010110","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"25021010110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":103.47,"discounted_cash":72.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021011199","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"25021011199","type":"NDC"}],"standard_charges":[{"gross_charge":418.55,"discounted_cash":292.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021011210","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"25021011210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021011387","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011387","type":"NDC"}],"standard_charges":[{"gross_charge":197.5,"discounted_cash":138.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021011504","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"25021011504","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021011506","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"25021011506","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021011551","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"25021011551","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR INJ 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021011810","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"25021011810","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021011920","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"25021011920","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012120","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"25021012120","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":113.09,"discounted_cash":79.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 6 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012999","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012999","type":"NDC"}],"standard_charges":[{"gross_charge":326.22,"discounted_cash":228.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013510","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013610","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013720","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013910","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"25021013910","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014010","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"25021014010","type":"NDC"}],"standard_charges":[{"gross_charge":328.16,"discounted_cash":229.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014330","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"gross_charge":128.24,"discounted_cash":89.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014830","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"25021014830","type":"NDC"}],"standard_charges":[{"gross_charge":132.66,"discounted_cash":92.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015899","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"25021015899","type":"NDC"}],"standard_charges":[{"gross_charge":516.59,"discounted_cash":361.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx25021016430","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021016430","type":"NDC"}],"standard_charges":[{"gross_charge":102.82,"discounted_cash":71.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx25021016530","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021016530","type":"NDC"}],"standard_charges":[{"gross_charge":135.54,"discounted_cash":94.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021016648","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021016648","type":"NDC"}],"standard_charges":[{"gross_charge":213.01,"discounted_cash":149.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx25021017620","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021017620","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021018010","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"25021018010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021018467","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018467","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021018487","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":196.04,"discounted_cash":137.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPIRUBICIN HCL IV SOLN 50 MG/25ML (2 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx25021020325","type":"CDM"},{"code":"J9178","type":"HCPCS"},{"code":"25021020325","type":"NDC"}],"standard_charges":[{"gross_charge":855.2,"discounted_cash":598.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":403.18,"discounted_cash":282.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021023005","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"25021023005","type":"NDC"}],"standard_charges":[{"gross_charge":276.04,"discounted_cash":193.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":192.1,"discounted_cash":134.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPOTECAN HCL INJ 4 MG/4ML (BASE EQUIV) (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx25021023604","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"25021023604","type":"NDC"}],"standard_charges":[{"gross_charge":506.72,"discounted_cash":354.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx25021024504","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"25021024504","type":"NDC"}],"standard_charges":[{"gross_charge":495.17,"discounted_cash":346.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NELARABINE IV SOLN 5 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021025950","type":"CDM"},{"code":"J9261","type":"HCPCS"},{"code":"25021025950","type":"NDC"}],"standard_charges":[{"gross_charge":943.86,"discounted_cash":660.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ADENOSINE IV SOLN 12 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021030104","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"25021030104","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":460.62,"discounted_cash":322.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":460.62,"discounted_cash":322.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021031382","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"25021031382","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021031599","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"25021031599","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031802","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"25021031802","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021032110","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"25021032110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021040010","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021040010","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx25021040030","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040030","type":"NDC"}],"standard_charges":[{"gross_charge":151.85,"discounted_cash":106.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"},{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx25021040030","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040030","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx25021040210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021040301","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx25021046001","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"25021046001","type":"NDC"}],"standard_charges":[{"gross_charge":115.49,"discounted_cash":80.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021046274","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"25021046274","type":"NDC"}],"standard_charges":[{"gross_charge":1098.81,"discounted_cash":769.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":829.98,"discounted_cash":580.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021061282","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"25021061282","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021065287","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"25021065287","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021066205","type":"CDM"},{"code":"25021066205","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021067187","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"25021067187","type":"NDC"}],"standard_charges":[{"gross_charge":442.02,"discounted_cash":309.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021067187","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"25021067187","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":60.08,"discounted_cash":42.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN INTRATHECAL INJ 10 MG/20ML (500 MCG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx25021067820","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"25021067820","type":"NDC"}],"standard_charges":[{"gross_charge":991.2,"discounted_cash":693.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN INTRATHECAL SOLN PREFILLED SYRINGE 50 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021068171","type":"CDM"},{"code":"J0476","type":"HCPCS"},{"code":"25021068171","type":"NDC"}],"standard_charges":[{"gross_charge":131.65,"discounted_cash":92.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021068405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021068405","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021068510","type":"CDM"},{"code":"25021068510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021070360","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"25021070360","type":"NDC"}],"standard_charges":[{"gross_charge":314.02,"discounted_cash":219.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021077702","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"25021077702","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GRANISETRON HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021077901","type":"CDM"},{"code":"J1626","type":"HCPCS"},{"code":"25021077901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021080601","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"25021080601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":302.41,"discounted_cash":211.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081430","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081430","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081530","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081530","type":"NDC"}],"standard_charges":[{"gross_charge":240.39,"discounted_cash":168.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":179.6,"discounted_cash":125.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 4 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021082667","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"25021082667","type":"NDC"}],"standard_charges":[{"gross_charge":353.34,"discounted_cash":247.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":353.34,"discounted_cash":247.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":530.79,"discounted_cash":371.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25208000305","type":"CDM"},{"code":"25208000305","type":"NDC"}],"standard_charges":[{"gross_charge":734.58,"discounted_cash":514.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":26480.75,"discounted_cash":18536.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RAVULIZUMAB-CWVZ IV SOLN 300 MG/3ML (100 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx25682002501","type":"CDM"},{"code":"J1303","type":"HCPCS"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":25997.67,"discounted_cash":18198.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.42,"discounted_cash":8.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241009903","type":"CDM"},{"code":"27241009903","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TADALAFIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241011403","type":"CDM"},{"code":"27241011403","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx27241013909","type":"CDM"},{"code":"27241013909","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":15.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILODOSIN CAP 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241014501","type":"CDM"},{"code":"27241014501","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILODOSIN CAP 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241014503","type":"CDM"},{"code":"27241014503","type":"NDC"}],"standard_charges":[{"gross_charge":11.37,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27437005056","type":"CDM"},{"code":"27437005056","type":"NDC"}],"standard_charges":[{"gross_charge":117.95,"discounted_cash":82.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27505000368","type":"CDM"},{"code":"27505000368","type":"NDC"}],"standard_charges":[{"gross_charge":1021.57,"discounted_cash":715.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THEOPHYLLINE SOLN 80 MG/15ML","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx27808003301","type":"CDM"},{"code":"27808003301","type":"NDC"}],"standard_charges":[{"gross_charge":88.84,"discounted_cash":62.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 9 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27808022501","type":"CDM"},{"code":"27808022501","type":"NDC"}],"standard_charges":[{"gross_charge":15.54,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300011101","type":"CDM"},{"code":"29300011101","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TADALAFIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300028913","type":"CDM"},{"code":"29300028913","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":208736.55,"discounted_cash":146115.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLECALCIFEROL DROPS 125 MCG/ML (5000 UNIT/ML)","drug_information":{"unit":0.08,"type":"ML"},"code_information":[{"code":"Rx30768030405","type":"CDM"},{"code":"30768030405","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31604001281","type":"CDM"},{"code":"31604001281","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ITRACONAZOLE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx31722000631","type":"CDM"},{"code":"31722000631","type":"NDC"}],"standard_charges":[{"gross_charge":28.72,"discounted_cash":20.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENALAPRIL MALEATE ORAL SOLN 1 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx31722002015","type":"CDM"},{"code":"31722002015","type":"NDC"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IVABRADINE HCL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722005360","type":"CDM"},{"code":"31722005360","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx31722011633","type":"CDM"},{"code":"31722011633","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx31722011634","type":"CDM"},{"code":"31722011634","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx31722011650","type":"CDM"},{"code":"31722011650","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722022801","type":"CDM"},{"code":"31722022801","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722023990","type":"CDM"},{"code":"31722023990","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722025301","type":"CDM"},{"code":"31722025301","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722027630","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"31722027630","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722027634","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"31722027634","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722027860","type":"CDM"},{"code":"31722027860","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722028060","type":"CDM"},{"code":"31722028060","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":189.68,"discounted_cash":132.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx31722039410","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"31722039410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx31722039431","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"31722039431","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx31722039432","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"31722039432","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx31722039433","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"31722039433","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053001","type":"CDM"},{"code":"31722053001","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053101","type":"CDM"},{"code":"31722053101","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053401","type":"CDM"},{"code":"31722053401","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722062160","type":"CDM"},{"code":"31722062160","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RUFINAMIDE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722068846","type":"CDM"},{"code":"31722068846","type":"NDC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACOSAMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722081360","type":"CDM"},{"code":"31722081360","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx31722099510","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"31722099510","type":"NDC"}],"standard_charges":[{"gross_charge":124.81,"discounted_cash":87.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx31722099531","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"31722099531","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx33216074199","type":"CDM"},{"code":"33216074199","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx33216074818","type":"CDM"},{"code":"33216074818","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx33216077168","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"33216077168","type":"NDC"}],"standard_charges":[{"gross_charge":115.27,"discounted_cash":80.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 5 MG/5ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx33216078303","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"33216078303","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342003110","type":"CDM"},{"code":"33342003110","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008407","type":"CDM"},{"code":"33342008407","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008607","type":"CDM"},{"code":"33342008607","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342015711","type":"CDM"},{"code":"33342015711","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342025666","type":"CDM"},{"code":"33342025666","type":"NDC"}],"standard_charges":[{"gross_charge":13.47,"discounted_cash":9.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RASAGILINE MESYLATE TAB 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342030907","type":"CDM"},{"code":"33342030907","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":56.06,"discounted_cash":39.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx33342040535","type":"CDM"},{"code":"33342040535","type":"NDC"}],"standard_charges":[{"gross_charge":77.23,"discounted_cash":54.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000210","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000210","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx36000000306","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000000306","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000000306","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000000310","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000310","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000001225","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"36000001225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx36000003310","type":"CDM"},{"code":"36000003310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000006401","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000006401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000006401","type":"CDM"},{"code":"36000006401","type":"NDC"}],"standard_charges":[{"gross_charge":51.23,"discounted_cash":35.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx36000009201","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"36000009201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028225","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028325","type":"CDM"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":51.4,"discounted_cash":35.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028425","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000028806","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000028806","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx36000030660","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"36000030660","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx36000031001","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"36000031001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx36000031002","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"36000031002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETRAHYDROZOLINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx37205013905","type":"CDM"},{"code":"37205013905","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37205027078","type":"CDM"},{"code":"37205027078","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB 250-250-65 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37205028062","type":"CDM"},{"code":"37205028062","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx37205045705","type":"CDM"},{"code":"37205045705","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE ORAL GRANULES","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx37205060243","type":"CDM"},{"code":"37205060243","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB 250-250-65 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37205070378","type":"CDM"},{"code":"37205070378","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx37205087134","type":"CDM"},{"code":"37205087134","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37864000033","type":"CDM"},{"code":"37864000033","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VANCOMYCIN HCL (BULK) POWDER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx38779027406","type":"CDM"},{"code":"38779027406","type":"NDC"}],"standard_charges":[{"gross_charge":136.17,"discounted_cash":95.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM BENZOATE POWDER","drug_information":{"unit":500.0,"type":"GM"},"code_information":[{"code":"Rx38779055108","type":"CDM"},{"code":"38779055108","type":"NDC"}],"standard_charges":[{"gross_charge":198.75,"discounted_cash":139.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BIOTIN (BULK) POWDER","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx38779200403","type":"CDM"},{"code":"38779200403","type":"NDC"}],"standard_charges":[{"gross_charge":161.59,"discounted_cash":113.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx39328002405","type":"CDM"},{"code":"39328002405","type":"NDC"}],"standard_charges":[{"gross_charge":6.65,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39328002924","type":"CDM"},{"code":"39328002924","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE SOLN 75 MG/ML (15 MG/ML ELEMENTAL FE)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx39328005750","type":"CDM"},{"code":"39328005750","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.5%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx39328006250","type":"CDM"},{"code":"39328006250","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.25%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx39328006325","type":"CDM"},{"code":"39328006325","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.24,"discounted_cash":9.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.125%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx39328006712","type":"CDM"},{"code":"39328006712","type":"NDC"}],"standard_charges":[{"gross_charge":27.9,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.49,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.84,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE SOLN 75 MG/ML (15 MG/ML ELEMENTAL FE)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx39328055750","type":"CDM"},{"code":"39328055750","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":5.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39423000050","type":"CDM"},{"code":"39423000050","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39423066048","type":"CDM"},{"code":"39423066048","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIOTHYRONINE SODIUM IV SOLN 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx39822015101","type":"CDM"},{"code":"39822015101","type":"NDC"}],"standard_charges":[{"gross_charge":1290.21,"discounted_cash":903.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822016605","type":"CDM"},{"code":"39822016605","type":"NDC"}],"standard_charges":[{"gross_charge":117.81,"discounted_cash":82.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822017001","type":"CDM"},{"code":"39822017001","type":"NDC"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":81.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822017002","type":"CDM"},{"code":"39822017002","type":"NDC"}],"standard_charges":[{"gross_charge":166.66,"discounted_cash":116.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":426.27,"discounted_cash":298.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN SULFATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822031005","type":"CDM"},{"code":"39822031005","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN SULFATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822031007","type":"CDM"},{"code":"39822031007","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822041201","type":"CDM"},{"code":"39822041201","type":"NDC"}],"standard_charges":[{"gross_charge":816.14,"discounted_cash":571.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822041206","type":"CDM"},{"code":"39822041206","type":"NDC"}],"standard_charges":[{"gross_charge":937.59,"discounted_cash":656.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":550.14,"discounted_cash":385.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHOTERICIN B FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822105507","type":"CDM"},{"code":"J0285","type":"HCPCS"},{"code":"39822105507","type":"NDC"}],"standard_charges":[{"gross_charge":302.1,"discounted_cash":211.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822107701","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"39822107701","type":"NDC"}],"standard_charges":[{"gross_charge":582.89,"discounted_cash":408.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN B GU IRRIGATION SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx39822120102","type":"CDM"},{"code":"39822120102","type":"NDC"}],"standard_charges":[{"gross_charge":163.71,"discounted_cash":114.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822180001","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"39822180001","type":"NDC"}],"standard_charges":[{"gross_charge":189.52,"discounted_cash":132.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":251.37,"discounted_cash":175.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx39822301501","type":"CDM"},{"code":"39822301501","type":"NDC"}],"standard_charges":[{"gross_charge":90.1,"discounted_cash":63.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR NEBULIZATION SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822303002","type":"CDM"},{"code":"J2545","type":"HCPCS"},{"code":"39822303002","type":"NDC"}],"standard_charges":[{"gross_charge":140.38,"discounted_cash":98.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1181.65,"discounted_cash":827.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx39822420001","type":"CDM"},{"code":"39822420001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx39822420002","type":"CDM"},{"code":"39822420002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985021339","type":"CDM"},{"code":"40985021339","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985022368","type":"CDM"},{"code":"40985022368","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIACIN TAB ER 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985022849","type":"CDM"},{"code":"40985022849","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP DELAYED RELEASE 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985022873","type":"CDM"},{"code":"40985022873","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BIOTIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985027757","type":"CDM"},{"code":"40985027757","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx41100081123","type":"CDM"},{"code":"41100081123","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx41100081127","type":"CDM"},{"code":"41100081127","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXYLAMINE SUCCINATE (SLEEP) TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx41167000607","type":"CDM"},{"code":"41167000607","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXYLAMINE SUCCINATE (SLEEP) TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx41167000609","type":"CDM"},{"code":"41167000609","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXYLAMINE SUCCINATE (SLEEP) TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx41167000623","type":"CDM"},{"code":"41167000623","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6.12,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx41167005743","type":"CDM"},{"code":"41167005743","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx41167057303","type":"CDM"},{"code":"41167057303","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TROLAMINE SALICYLATE CREAM 10%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx41167073003","type":"CDM"},{"code":"41167073003","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx41388000730","type":"CDM"},{"code":"41388000730","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx41616022090","type":"CDM"},{"code":"41616022090","type":"NDC"}],"standard_charges":[{"gross_charge":82.83,"discounted_cash":57.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx42023010405","type":"CDM"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"gross_charge":125.02,"discounted_cash":87.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOHEXITAL SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023010501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023010501","type":"NDC"}],"standard_charges":[{"gross_charge":1217.5,"discounted_cash":852.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COLISTIMETHATE SOD FOR INJ 150 MG (COLISTIN BASE ACTIVITY)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023010701","type":"CDM"},{"code":"J0770","type":"HCPCS"},{"code":"42023010701","type":"NDC"}],"standard_charges":[{"gross_charge":152.95,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx42023011410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023011410","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023011510","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIOTHYRONINE SODIUM IV SOLN 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023012001","type":"CDM"},{"code":"42023012001","type":"NDC"}],"standard_charges":[{"gross_charge":1550.31,"discounted_cash":1085.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIOTHYRONINE SODIUM IV SOLN 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023012006","type":"CDM"},{"code":"42023012006","type":"NDC"}],"standard_charges":[{"gross_charge":1512.51,"discounted_cash":1058.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023012306","type":"CDM"},{"code":"42023012306","type":"NDC"}],"standard_charges":[{"gross_charge":1050.52,"discounted_cash":735.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx42023013901","type":"CDM"},{"code":"42023013901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023014401","type":"CDM"},{"code":"42023014401","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42023014625","type":"CDM"},{"code":"42023014625","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023015701","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"42023015701","type":"NDC"}],"standard_charges":[{"gross_charge":2083.04,"discounted_cash":1458.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx42023015901","type":"CDM"},{"code":"42023015901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023015925","type":"CDM"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":293.8,"discounted_cash":205.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023017204","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"42023017204","type":"NDC"}],"standard_charges":[{"gross_charge":389.86,"discounted_cash":272.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE HCL INJ 0.3 MG/ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023017901","type":"CDM"},{"code":"J0592","type":"HCPCS"},{"code":"42023017901","type":"NDC"}],"standard_charges":[{"gross_charge":184.29,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE HCL INJ 0.3 MG/ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023017905","type":"CDM"},{"code":"J0592","type":"HCPCS"},{"code":"42023017905","type":"NDC"}],"standard_charges":[{"gross_charge":182.84,"discounted_cash":127.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":976.41,"discounted_cash":683.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023022101","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"42023022101","type":"NDC"}],"standard_charges":[{"gross_charge":736.88,"discounted_cash":515.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023022110","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"gross_charge":561.28,"discounted_cash":392.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VASOPRESSIN-DEXTROSE IV SOLN 20 UNIT/100ML-5% (0.2UNIT/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx42023023701","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023023701","type":"NDC"}],"standard_charges":[{"gross_charge":1923.63,"discounted_cash":1346.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VASOPRESSIN-DEXTROSE IV SOLN 20 UNIT/100ML-5% (0.2UNIT/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx42023023710","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023023710","type":"NDC"}],"standard_charges":[{"gross_charge":536.96,"discounted_cash":375.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6.39,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42043014338","type":"CDM"},{"code":"42043014338","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THYROID TAB 30 MG (1/2 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192032901","type":"CDM"},{"code":"42192032901","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192033001","type":"CDM"},{"code":"42192033001","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42192060806","type":"CDM"},{"code":"42192060806","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42192060840","type":"CDM"},{"code":"42192060840","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx42291037935","type":"CDM"},{"code":"42291037935","type":"NDC"}],"standard_charges":[{"gross_charge":155.51,"discounted_cash":108.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.27,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292000120","type":"CDM"},{"code":"42292000120","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292000201","type":"CDM"},{"code":"42292000201","type":"NDC"}],"standard_charges":[{"gross_charge":12.45,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292000220","type":"CDM"},{"code":"42292000220","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292000320","type":"CDM"},{"code":"42292000320","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292001101","type":"CDM"},{"code":"42292001101","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292001106","type":"CDM"},{"code":"42292001106","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292001320","type":"CDM"},{"code":"42292001320","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292002601","type":"CDM"},{"code":"42292002601","type":"NDC"}],"standard_charges":[{"gross_charge":52.74,"discounted_cash":36.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292002620","type":"CDM"},{"code":"42292002620","type":"NDC"}],"standard_charges":[{"gross_charge":54.07,"discounted_cash":37.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292004001","type":"CDM"},{"code":"42292004001","type":"NDC"}],"standard_charges":[{"gross_charge":11.38,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292004020","type":"CDM"},{"code":"42292004020","type":"NDC"}],"standard_charges":[{"gross_charge":11.52,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARGATROBAN IV SOLN 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx42367020307","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"42367020307","type":"NDC"}],"standard_charges":[{"gross_charge":2346.23,"discounted_cash":1642.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7593.77,"discounted_cash":5315.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":155.58,"discounted_cash":108.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":336.05,"discounted_cash":235.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":152.09,"discounted_cash":106.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42494041905","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42494041905","type":"NDC"}],"standard_charges":[{"gross_charge":1129.45,"discounted_cash":790.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx42543005261","type":"CDM"},{"code":"42543005261","type":"NDC"}],"standard_charges":[{"gross_charge":101.89,"discounted_cash":71.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543070490","type":"CDM"},{"code":"42543070490","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42571013725","type":"CDM"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":74.27,"discounted_cash":51.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571016242","type":"CDM"},{"code":"42571016242","type":"NDC"}],"standard_charges":[{"gross_charge":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx42571024469","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"42571024469","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBAZAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571031501","type":"CDM"},{"code":"42571031501","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571034201","type":"CDM"},{"code":"42571034201","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE PF OPHTH SOLN 2-0.5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571038271","type":"CDM"},{"code":"42571038271","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE PF OPHTH SOLN 2-0.5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571038273","type":"CDM"},{"code":"42571038273","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DAUNORUBICIN HCL IV SOLN 20 MG/4ML (BASE EQUIV)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx42658002101","type":"CDM"},{"code":"J9150","type":"HCPCS"},{"code":"42658002101","type":"NDC"}],"standard_charges":[{"gross_charge":757.61,"discounted_cash":530.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUROSUMAB-TWZA INJ 20 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx42747020301","type":"CDM"},{"code":"J0584","type":"HCPCS"},{"code":"42747020301","type":"NDC"}],"standard_charges":[{"gross_charge":18156.0,"discounted_cash":12709.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUCYTOSINE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42794001008","type":"CDM"},{"code":"42794001008","type":"NDC"}],"standard_charges":[{"gross_charge":107.24,"discounted_cash":75.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42794001802","type":"CDM"},{"code":"42794001802","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42794001912","type":"CDM"},{"code":"42794001912","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IVERMECTIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42799080601","type":"CDM"},{"code":"42799080601","type":"NDC"}],"standard_charges":[{"gross_charge":17.21,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEPERIDINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806005001","type":"CDM"},{"code":"42806005001","type":"NDC"}],"standard_charges":[{"gross_charge":12.83,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806014301","type":"CDM"},{"code":"42806014301","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.15,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806031050","type":"CDM"},{"code":"42806031050","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806035830","type":"CDM"},{"code":"42806035830","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806035925","type":"CDM"},{"code":"42806035925","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":12.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUINIDINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806051330","type":"CDM"},{"code":"42806051330","type":"NDC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":21.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806054701","type":"CDM"},{"code":"42806054701","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806071401","type":"CDM"},{"code":"42806071401","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BEVACIZUMAB INTRAVITREAL SOLN PREF SYR 1.25 MG/0.05ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx42852000116","type":"CDM"},{"code":"C9257","type":"HCPCS"},{"code":"42852000116","type":"NDC"}],"standard_charges":[{"gross_charge":810.9,"discounted_cash":567.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.31,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18.3,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.82,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THEOPHYLLINE TAB ER 24HR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858070101","type":"CDM"},{"code":"42858070101","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858080201","type":"CDM"},{"code":"42858080201","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858080401","type":"CDM"},{"code":"42858080401","type":"NDC"}],"standard_charges":[{"gross_charge":13.22,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 5000-17000-24000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42865030002","type":"CDM"},{"code":"42865030002","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 15000-47000-63000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42865030202","type":"CDM"},{"code":"42865030202","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":13.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 20000-63000-84000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42865030302","type":"CDM"},{"code":"42865030302","type":"NDC"}],"standard_charges":[{"gross_charge":19.18,"discounted_cash":13.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 3000-10000-14000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42865030402","type":"CDM"},{"code":"42865030402","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 10000-32000-42000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42865030602","type":"CDM"},{"code":"42865030602","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOBARBITAL SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42998030301","type":"CDM"},{"code":"J0300","type":"HCPCS"},{"code":"42998030301","type":"NDC"}],"standard_charges":[{"gross_charge":2715.05,"discounted_cash":1900.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43066000710","type":"CDM"},{"code":"43066000710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":888.76,"discounted_cash":622.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":208.3,"discounted_cash":145.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43066055712","type":"CDM"},{"code":"43066055712","type":"NDC"}],"standard_charges":[{"gross_charge":364.14,"discounted_cash":254.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199001101","type":"CDM"},{"code":"43199001101","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199002112","type":"CDM"},{"code":"43199002112","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx43199002915","type":"CDM"},{"code":"43199002915","type":"NDC"}],"standard_charges":[{"gross_charge":76.28,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIACIN TAB ER 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43292055703","type":"CDM"},{"code":"43292055703","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE FOR SUSP 40 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx43386003860","type":"CDM"},{"code":"43386003860","type":"NDC"}],"standard_charges":[{"gross_charge":50.03,"discounted_cash":35.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40.04,"discounted_cash":28.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386014001","type":"CDM"},{"code":"43386014001","type":"NDC"}],"standard_charges":[{"gross_charge":11.99,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386014028","type":"CDM"},{"code":"43386014028","type":"NDC"}],"standard_charges":[{"gross_charge":103.28,"discounted_cash":72.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386016006","type":"CDM"},{"code":"43386016006","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIMETHOPRIM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386033001","type":"CDM"},{"code":"43386033001","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43478090188","type":"CDM"},{"code":"43478090188","type":"NDC"}],"standard_charges":[{"gross_charge":13.48,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027010","type":"CDM"},{"code":"43547027010","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027110","type":"CDM"},{"code":"43547027110","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027509","type":"CDM"},{"code":"43547027509","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027609","type":"CDM"},{"code":"43547027609","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547033510","type":"CDM"},{"code":"43547033510","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547033710","type":"CDM"},{"code":"43547033710","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547034506","type":"CDM"},{"code":"43547034506","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547036809","type":"CDM"},{"code":"43547036809","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547054301","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547054301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547054325","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547054325","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598008511","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"43598008511","type":"NDC"}],"standard_charges":[{"gross_charge":524.62,"discounted_cash":367.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598008525","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"43598008525","type":"NDC"}],"standard_charges":[{"gross_charge":138.33,"discounted_cash":96.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598012725","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598012725","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598012745","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598012745","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":212.58,"discounted_cash":148.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598012901","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598012901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598012925","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598012925","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":190.95,"discounted_cash":133.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598016430","type":"CDM"},{"code":"43598016430","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598020451","type":"CDM"},{"code":"43598020451","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":400.0,"type":"GM"},"code_information":[{"code":"Rx43598021040","type":"CDM"},{"code":"43598021040","type":"NDC"}],"standard_charges":[{"gross_charge":191.03,"discounted_cash":133.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx43598021055","type":"CDM"},{"code":"43598021055","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":58.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 250-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598021830","type":"CDM"},{"code":"43598021830","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE OTIC SUSP 0.3-0.1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598032675","type":"CDM"},{"code":"43598032675","type":"NDC"}],"standard_charges":[{"gross_charge":355.02,"discounted_cash":248.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":205.83,"discounted_cash":144.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1028.87,"discounted_cash":720.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":226.25,"discounted_cash":158.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598043611","type":"CDM"},{"code":"43598043611","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598043635","type":"CDM"},{"code":"43598043635","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.31,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.65,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.55,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.65,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3.21,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044874","type":"CDM"},{"code":"43598044874","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22.8,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":26.56,"discounted_cash":18.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx43598054952","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"43598054952","type":"NDC"}],"standard_charges":[{"gross_charge":112.89,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"REGADENOSON IV INJ 0.4 MG/5ML (0.08 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598061611","type":"CDM"},{"code":"J2785","type":"HCPCS"},{"code":"43598061611","type":"NDC"}],"standard_charges":[{"gross_charge":134.35,"discounted_cash":94.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598063552","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598063552","type":"NDC"}],"standard_charges":[{"gross_charge":178.98,"discounted_cash":125.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598063610","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598063610","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598063652","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598063652","type":"NDC"}],"standard_charges":[{"gross_charge":291.62,"discounted_cash":204.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598064160","type":"CDM"},{"code":"43598064160","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 97-103 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598064560","type":"CDM"},{"code":"43598064560","type":"NDC"}],"standard_charges":[{"gross_charge":12.63,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":275.62,"discounted_cash":192.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":289.8,"discounted_cash":202.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLOPATADINE HCL OPHTH SOLN 0.1% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598076507","type":"CDM"},{"code":"43598076507","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598090111","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"43598090111","type":"NDC"}],"standard_charges":[{"gross_charge":655.27,"discounted_cash":458.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43825010201","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"43825010201","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx43825010201","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"43825010201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLUTAMINE POWD PACK 15 GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx43900028300","type":"CDM"},{"code":"43900028300","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INTERFERON BETA-1A SOLN PREF SYR 22 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx44087002203","type":"CDM"},{"code":"Q3028","type":"HCPCS"},{"code":"44087002203","type":"NDC"}],"standard_charges":[{"gross_charge":3424.44,"discounted_cash":2397.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44206031025","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"44206031025","type":"NDC"}],"standard_charges":[{"gross_charge":524.7,"discounted_cash":367.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44206031090","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"44206031090","type":"NDC"}],"standard_charges":[{"gross_charge":524.7,"discounted_cash":367.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2305.81,"discounted_cash":1614.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4611.62,"discounted_cash":3228.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9223.24,"discounted_cash":6456.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 40 GM/400ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx44206043940","type":"CDM"},{"code":"J1459","type":"HCPCS"},{"code":"44206043940","type":"NDC"}],"standard_charges":[{"gross_charge":18446.49,"discounted_cash":12912.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6165.49,"discounted_cash":4315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR IV SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567010401","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"44567010401","type":"NDC"}],"standard_charges":[{"gross_charge":271.89,"discounted_cash":190.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567021010","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"44567021010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567021110","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567022110","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"44567022110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 6 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567023706","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"44567023706","type":"NDC"}],"standard_charges":[{"gross_charge":239.29,"discounted_cash":167.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024010","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024110","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"gross_charge":116.29,"discounted_cash":81.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024525","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"44567024525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":103.47,"discounted_cash":72.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024710","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"44567024710","type":"NDC"}],"standard_charges":[{"gross_charge":426.66,"discounted_cash":298.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567040010","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"44567040010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567040201","type":"CDM"},{"code":"J2183","type":"HCPCS"},{"code":"44567040201","type":"NDC"}],"standard_charges":[{"gross_charge":475.04,"discounted_cash":332.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567040206","type":"CDM"},{"code":"J2183","type":"HCPCS"},{"code":"44567040206","type":"NDC"}],"standard_charges":[{"gross_charge":455.42,"discounted_cash":318.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567042100","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567042100","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567042124","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567042124","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1072.17,"discounted_cash":750.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1018.38,"discounted_cash":712.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567045101","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"44567045101","type":"NDC"}],"standard_charges":[{"gross_charge":948.02,"discounted_cash":663.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567045110","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"44567045110","type":"NDC"}],"standard_charges":[{"gross_charge":953.57,"discounted_cash":667.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567050101","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"44567050101","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567050210","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"44567050210","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CISPLATIN IV FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567053001","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"44567053001","type":"NDC"}],"standard_charges":[{"gross_charge":1814.86,"discounted_cash":1270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567062101","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062101","type":"NDC"}],"standard_charges":[{"gross_charge":254.59,"discounted_cash":178.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567062102","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"44567062102","type":"NDC"}],"standard_charges":[{"gross_charge":254.59,"discounted_cash":178.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567062124","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062124","type":"NDC"}],"standard_charges":[{"gross_charge":254.59,"discounted_cash":178.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064001","type":"CDM"},{"code":"44567064001","type":"NDC"}],"standard_charges":[{"gross_charge":370.32,"discounted_cash":259.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064010","type":"CDM"},{"code":"44567064010","type":"NDC"}],"standard_charges":[{"gross_charge":254.59,"discounted_cash":178.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070225","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"44567070225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070301","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"44567070301","type":"NDC"}],"standard_charges":[{"gross_charge":132.28,"discounted_cash":92.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":145.73,"discounted_cash":102.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070625","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"44567070625","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070810","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"gross_charge":160.16,"discounted_cash":112.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx44567080310","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"44567080310","type":"NDC"}],"standard_charges":[{"gross_charge":217.81,"discounted_cash":152.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":771.22,"discounted_cash":539.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567084501","type":"CDM"},{"code":"J0687","type":"HCPCS"},{"code":"44567084501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567084525","type":"CDM"},{"code":"J0687","type":"HCPCS"},{"code":"44567084525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.82,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN SULFATE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802004635","type":"CDM"},{"code":"45802004635","type":"NDC"}],"standard_charges":[{"gross_charge":158.57,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802004835","type":"CDM"},{"code":"45802004835","type":"NDC"}],"standard_charges":[{"gross_charge":87.59,"discounted_cash":61.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIBUCAINE PERIANAL OINTMENT 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802005003","type":"CDM"},{"code":"45802005003","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802005535","type":"CDM"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":43.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":70.7,"discounted_cash":49.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802005935","type":"CDM"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":61.89,"discounted_cash":43.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.84,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACITRACIN OINT 500 UNIT/GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802006070","type":"CDM"},{"code":"45802006070","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802006170","type":"CDM"},{"code":"45802006170","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":28.96,"discounted_cash":20.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":27.28,"discounted_cash":19.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":75.13,"discounted_cash":52.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802014370","type":"CDM"},{"code":"45802014370","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802024414","type":"CDM"},{"code":"45802024414","type":"NDC"}],"standard_charges":[{"gross_charge":92.26,"discounted_cash":64.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE OINT 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802027603","type":"CDM"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802035803","type":"CDM"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTIC ACID (AMMONIUM LACTATE) LOTION 12%","drug_information":{"unit":225.0,"type":"GM"},"code_information":[{"code":"Rx45802041954","type":"CDM"},{"code":"45802041954","type":"NDC"}],"standard_charges":[{"gross_charge":18.67,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.1,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7.49,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE SOLN 1%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx45802056201","type":"CDM"},{"code":"45802056201","type":"NDC"}],"standard_charges":[{"gross_charge":77.61,"discounted_cash":54.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CETIRIZINE HCL ORAL SOLN 1 MG/ML (5 MG/5ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx45802062626","type":"CDM"},{"code":"45802062626","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073032","type":"CDM"},{"code":"45802073032","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802075900","type":"CDM"},{"code":"45802075900","type":"NDC"}],"standard_charges":[{"gross_charge":27.01,"discounted_cash":18.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802075930","type":"CDM"},{"code":"45802075930","type":"NDC"}],"standard_charges":[{"gross_charge":27.07,"discounted_cash":18.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802081184","type":"CDM"},{"code":"45802081184","type":"NDC"}],"standard_charges":[{"gross_charge":49.53,"discounted_cash":34.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx45802095301","type":"CDM"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963034102","type":"CDM"},{"code":"45963034102","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTULOSE (ENCEPHALOPATHY) SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx45963043864","type":"CDM"},{"code":"45963043864","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963055611","type":"CDM"},{"code":"45963055611","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXALIPLATIN FOR IV INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963061153","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"45963061153","type":"NDC"}],"standard_charges":[{"gross_charge":492.21,"discounted_cash":344.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":844.02,"discounted_cash":590.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx45963090642","type":"CDM"},{"code":"45963090642","type":"NDC"}],"standard_charges":[{"gross_charge":282.79,"discounted_cash":197.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAFFEINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx46017001840","type":"CDM"},{"code":"46017001840","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":51.52,"discounted_cash":36.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SPIRONOLACTONE SUSP 25 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx46287002004","type":"CDM"},{"code":"46287002004","type":"NDC"}],"standard_charges":[{"gross_charge":21.71,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SORBITOL SOLUTION (BULK)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx46287050030","type":"CDM"},{"code":"46287050030","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2463.35,"discounted_cash":1724.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1794.96,"discounted_cash":1256.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.87,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN NEBU SOLN 300 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx47335017148","type":"CDM"},{"code":"J7682","type":"HCPCS"},{"code":"47335017148","type":"NDC"}],"standard_charges":[{"gross_charge":30.26,"discounted_cash":21.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOBRAMYCIN NEBU SOLN 300 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx47335017149","type":"CDM"},{"code":"J7682","type":"HCPCS"},{"code":"47335017149","type":"NDC"}],"standard_charges":[{"gross_charge":30.26,"discounted_cash":21.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXALIPLATIN FOR IV INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335017640","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"47335017640","type":"NDC"}],"standard_charges":[{"gross_charge":1567.5,"discounted_cash":1097.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":51740.64,"discounted_cash":36218.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx47335022090","type":"CDM"},{"code":"47335022090","type":"NDC"}],"standard_charges":[{"gross_charge":135.36,"discounted_cash":94.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx47335028940","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"47335028940","type":"NDC"}],"standard_charges":[{"gross_charge":310.86,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NALTREXONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335032683","type":"CDM"},{"code":"47335032683","type":"NDC"}],"standard_charges":[{"gross_charge":11.86,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335036141","type":"CDM"},{"code":"J0893","type":"HCPCS"},{"code":"47335036141","type":"NDC"}],"standard_charges":[{"gross_charge":1149.41,"discounted_cash":804.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx47335061540","type":"CDM"},{"code":"47335061540","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx47335061544","type":"CDM"},{"code":"47335061544","type":"NDC"}],"standard_charges":[{"gross_charge":127.39,"discounted_cash":89.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335067581","type":"CDM"},{"code":"47335067581","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335070786","type":"CDM"},{"code":"47335070786","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335074483","type":"CDM"},{"code":"47335074483","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335076583","type":"CDM"},{"code":"47335076583","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335076683","type":"CDM"},{"code":"47335076683","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMOZOLOMIDE CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335089160","type":"CDM"},{"code":"J8700","type":"HCPCS"},{"code":"47335089160","type":"NDC"}],"standard_charges":[{"gross_charge":19.41,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMOZOLOMIDE CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335089174","type":"CDM"},{"code":"J8700","type":"HCPCS"},{"code":"47335089174","type":"NDC"}],"standard_charges":[{"gross_charge":20.37,"discounted_cash":14.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx47335089540","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"47335089540","type":"NDC"}],"standard_charges":[{"gross_charge":510.73,"discounted_cash":357.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335090288","type":"CDM"},{"code":"47335090288","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx47335099202","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"47335099202","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":937.75,"discounted_cash":656.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE-MELOXICAM INJECTION ER SOLN 400-12 MG/14ML","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"Rx47426050102","type":"CDM"},{"code":"J0668","type":"HCPCS"},{"code":"47426050102","type":"NDC"}],"standard_charges":[{"gross_charge":1175.52,"discounted_cash":822.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47682022335","type":"CDM"},{"code":"47682022335","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47682080313","type":"CDM"},{"code":"47682080313","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEVIRAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781010060","type":"CDM"},{"code":"47781010060","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781020904","type":"CDM"},{"code":"47781020904","type":"NDC"}],"standard_charges":[{"gross_charge":38.76,"discounted_cash":27.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781020911","type":"CDM"},{"code":"47781020911","type":"NDC"}],"standard_charges":[{"gross_charge":38.26,"discounted_cash":26.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781030701","type":"CDM"},{"code":"47781030701","type":"NDC"}],"standard_charges":[{"gross_charge":12.52,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781030801","type":"CDM"},{"code":"47781030801","type":"NDC"}],"standard_charges":[{"gross_charge":14.14,"discounted_cash":9.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DAPSONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781033331","type":"CDM"},{"code":"47781033331","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DAPSONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781033431","type":"CDM"},{"code":"47781033431","type":"NDC"}],"standard_charges":[{"gross_charge":14.33,"discounted_cash":10.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.41,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.43,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx47781038426","type":"CDM"},{"code":"47781038426","type":"NDC"}],"standard_charges":[{"gross_charge":46.44,"discounted_cash":32.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042347","type":"CDM"},{"code":"47781042347","type":"NDC"}],"standard_charges":[{"gross_charge":39.78,"discounted_cash":27.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx47781046570","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"47781046570","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781046671","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"47781046671","type":"NDC"}],"standard_charges":[{"gross_charge":234.52,"discounted_cash":164.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781047013","type":"CDM"},{"code":"47781047013","type":"NDC"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781049701","type":"CDM"},{"code":"47781049701","type":"NDC"}],"standard_charges":[{"gross_charge":36.12,"discounted_cash":25.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETRACYCLINE HCL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781050801","type":"CDM"},{"code":"47781050801","type":"NDC"}],"standard_charges":[{"gross_charge":21.04,"discounted_cash":14.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx47781058493","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"47781058493","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx47781058717","type":"CDM"},{"code":"47781058717","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":"Rx47781058720","type":"CDM"},{"code":"47781058720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DISULFIRAM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781060730","type":"CDM"},{"code":"47781060730","type":"NDC"}],"standard_charges":[{"gross_charge":13.46,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781091413","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"47781091413","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACITRACIN OPHTH OINT 500 UNIT/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx48102000735","type":"CDM"},{"code":"48102000735","type":"NDC"}],"standard_charges":[{"gross_charge":206.38,"discounted_cash":144.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx48433012901","type":"CDM"},{"code":"48433012901","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE ORAL SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx48433020016","type":"CDM"},{"code":"48433020016","type":"NDC"}],"standard_charges":[{"gross_charge":46.82,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx48433021105","type":"CDM"},{"code":"48433021105","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.42,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IODINE SOLUTION STRONG 5% (LUGOL'S)","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"Rx48433023015","type":"CDM"},{"code":"48433023015","type":"NDC"}],"standard_charges":[{"gross_charge":139.91,"discounted_cash":97.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":7.13,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERRIC SUBSULFATE PASTE","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx48783011208","type":"CDM"},{"code":"48783011208","type":"NDC"}],"standard_charges":[{"gross_charge":106.68,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LACTOBACILLUS RHAMNOSUS (GG) CHEW TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49100040015","type":"CDM"},{"code":"49100040015","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROBIOTIC PRODUCT - LIQUID","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"Rx49100040053","type":"CDM"},{"code":"49100040053","type":"NDC"}],"standard_charges":[{"gross_charge":15.72,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021515","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":111.88,"discounted_cash":78.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021588","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021588","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RABIES VIRUS VACCINE, HDC FOR INJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281025251","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"49281025251","type":"NDC"}],"standard_charges":[{"gross_charge":1652.52,"discounted_cash":1156.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPH-AC PER-TET TOX AD-POLIOV-HAEMOPH B POLY VAC FOR IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281051105","type":"CDM"},{"code":"90698","type":"HCPCS"},{"code":"49281051105","type":"NDC"}],"standard_charges":[{"gross_charge":1149.12,"discounted_cash":804.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VACCINE FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281054503","type":"CDM"},{"code":"90648","type":"HCPCS"},{"code":"49281054503","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VACCINE FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281054505","type":"CDM"},{"code":"90648","type":"HCPCS"},{"code":"49281054505","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VACCINE FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281054758","type":"CDM"},{"code":"90648","type":"HCPCS"},{"code":"49281054758","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281059005","type":"CDM"},{"code":"90734","type":"HCPCS"},{"code":"49281059005","type":"NDC"}],"standard_charges":[{"gross_charge":302.47,"discounted_cash":211.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281059058","type":"CDM"},{"code":"90734","type":"HCPCS"},{"code":"49281059058","type":"NDC"}],"standard_charges":[{"gross_charge":294.58,"discounted_cash":206.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":168.54,"discounted_cash":117.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx49281075222","type":"CDM"},{"code":"49281075222","type":"NDC"}],"standard_charges":[{"gross_charge":131.31,"discounted_cash":91.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLIOVIRUS VACCINE, IPV INJ SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281086010","type":"CDM"},{"code":"90713","type":"HCPCS"},{"code":"49281086010","type":"NDC"}],"standard_charges":[{"gross_charge":117.85,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2628.37,"discounted_cash":1839.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483034010","type":"CDM"},{"code":"49483034010","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483060401","type":"CDM"},{"code":"49483060401","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483062401","type":"CDM"},{"code":"49483062401","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502010102","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502010102","type":"NDC"}],"standard_charges":[{"gross_charge":1688.85,"discounted_cash":1182.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502050101","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502050101","type":"NDC"}],"standard_charges":[{"gross_charge":1135.6,"discounted_cash":794.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502050102","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502050102","type":"NDC"}],"standard_charges":[{"gross_charge":1126.63,"discounted_cash":788.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx49502064015","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"49502064015","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMIVUDINE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx49702020548","type":"CDM"},{"code":"49702020548","type":"NDC"}],"standard_charges":[{"gross_charge":18.1,"discounted_cash":12.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIDOVUDINE IV SOLN 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx49702021305","type":"CDM"},{"code":"J3485","type":"HCPCS"},{"code":"49702021305","type":"NDC"}],"standard_charges":[{"gross_charge":433.75,"discounted_cash":303.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOLUTEGRAVIR SODIUM TAB 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49702022813","type":"CDM"},{"code":"49702022813","type":"NDC"}],"standard_charges":[{"gross_charge":142.96,"discounted_cash":100.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49730011130","type":"CDM"},{"code":"49730011130","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49730011230","type":"CDM"},{"code":"49730011230","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49730011330","type":"CDM"},{"code":"49730011330","type":"NDC"}],"standard_charges":[{"gross_charge":11.44,"discounted_cash":8.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE ORAL SOLN 1 MG/5ML","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx49884004233","type":"CDM"},{"code":"49884004233","type":"NDC"}],"standard_charges":[{"gross_charge":705.34,"discounted_cash":493.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884005401","type":"CDM"},{"code":"49884005401","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884009902","type":"CDM"},{"code":"49884009902","type":"NDC"}],"standard_charges":[{"gross_charge":19.74,"discounted_cash":13.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884011701","type":"CDM"},{"code":"49884011701","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VARENICLINE TARTRATE TAB 0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884015576","type":"CDM"},{"code":"49884015576","type":"NDC"}],"standard_charges":[{"gross_charge":11.86,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx49884016111","type":"CDM"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"gross_charge":180.23,"discounted_cash":126.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPAFENONE HCL CAP ER 12HR 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884021002","type":"CDM"},{"code":"49884021002","type":"NDC"}],"standard_charges":[{"gross_charge":22.91,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXANDROLONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884030101","type":"CDM"},{"code":"49884030101","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884031152","type":"CDM"},{"code":"49884031152","type":"NDC"}],"standard_charges":[{"gross_charge":16.13,"discounted_cash":11.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884031155","type":"CDM"},{"code":"49884031155","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884031552","type":"CDM"},{"code":"49884031552","type":"NDC"}],"standard_charges":[{"gross_charge":17.14,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884031555","type":"CDM"},{"code":"49884031555","type":"NDC"}],"standard_charges":[{"gross_charge":17.12,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884031591","type":"CDM"},{"code":"49884031591","type":"NDC"}],"standard_charges":[{"gross_charge":17.14,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032052","type":"CDM"},{"code":"49884032052","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032055","type":"CDM"},{"code":"49884032055","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032152","type":"CDM"},{"code":"49884032152","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032155","type":"CDM"},{"code":"49884032155","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032252","type":"CDM"},{"code":"49884032252","type":"NDC"}],"standard_charges":[{"gross_charge":13.33,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032255","type":"CDM"},{"code":"49884032255","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032352","type":"CDM"},{"code":"49884032352","type":"NDC"}],"standard_charges":[{"gross_charge":14.36,"discounted_cash":10.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032355","type":"CDM"},{"code":"49884032355","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":10.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884040152","type":"CDM"},{"code":"49884040152","type":"NDC"}],"standard_charges":[{"gross_charge":21.54,"discounted_cash":15.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884040291","type":"CDM"},{"code":"49884040291","type":"NDC"}],"standard_charges":[{"gross_charge":24.53,"discounted_cash":17.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884041201","type":"CDM"},{"code":"49884041201","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.67,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884046665","type":"CDM"},{"code":"49884046665","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":9.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884049401","type":"CDM"},{"code":"49884049401","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884050101","type":"CDM"},{"code":"49884050101","type":"NDC"}],"standard_charges":[{"gross_charge":34.41,"discounted_cash":24.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884051401","type":"CDM"},{"code":"49884051401","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884072401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"49884072401","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884082501","type":"CDM"},{"code":"49884082501","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884082909","type":"CDM"},{"code":"49884082909","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884083109","type":"CDM"},{"code":"49884083109","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884098501","type":"CDM"},{"code":"49884098501","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DAPSONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49938010130","type":"CDM"},{"code":"49938010130","type":"NDC"}],"standard_charges":[{"gross_charge":14.91,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DAPSONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49938010230","type":"CDM"},{"code":"49938010230","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50024043100","type":"CDM"},{"code":"50024043100","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50102021111","type":"CDM"},{"code":"50102021111","type":"NDC"}],"standard_charges":[{"gross_charge":8.32,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50102021113","type":"CDM"},{"code":"50102021113","type":"NDC"}],"standard_charges":[{"gross_charge":8.32,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ULIPRISTAL ACETATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50102091101","type":"CDM"},{"code":"50102091101","type":"NDC"}],"standard_charges":[{"gross_charge":71.9,"discounted_cash":50.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111033301","type":"CDM"},{"code":"50111033301","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111033401","type":"CDM"},{"code":"50111033401","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111043301","type":"CDM"},{"code":"50111043301","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111043401","type":"CDM"},{"code":"50111043401","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111046801","type":"CDM"},{"code":"50111046801","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111046901","type":"CDM"},{"code":"50111046901","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111064801","type":"CDM"},{"code":"50111064801","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111091601","type":"CDM"},{"code":"50111091601","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111091701","type":"CDM"},{"code":"50111091701","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 7%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx50190014123","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"50190014123","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50190014263","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"50190014263","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228014590","type":"CDM"},{"code":"50228014590","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228048201","type":"CDM"},{"code":"50228048201","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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":2195.25,"discounted_cash":1536.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15976.73,"discounted_cash":11183.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"},{"gross_charge":16460.88,"discounted_cash":11522.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RITUXIMAB IV SOLN 100 MG/10ML,RITUXIMAB IV SOLN 500 MG/50ML","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":3701.88,"discounted_cash":2591.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3140.12,"discounted_cash":2198.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":33935.93,"discounted_cash":23755.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15719.93,"discounted_cash":11003.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":224.79,"discounted_cash":157.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":285.27,"discounted_cash":199.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RITUXIMAB-HYALURONIDASE HUMAN INJ 1400-23400 MG-UNIT/11.7ML","drug_information":{"unit":11.7,"type":"ML"},"code_information":[{"code":"Rx50242010801","type":"CDM"},{"code":"J9311","type":"HCPCS"},{"code":"50242010801","type":"NDC"}],"standard_charges":[{"gross_charge":25913.07,"discounted_cash":18139.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":31039.66,"discounted_cash":21727.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":6140.49,"discounted_cash":4298.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1986.38,"discounted_cash":1390.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4966.01,"discounted_cash":3476.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":9932.02,"discounted_cash":6952.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":26874.09,"discounted_cash":18811.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH LOCATION"},{"gross_charge":83794.06,"discounted_cash":58655.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":31039.66,"discounted_cash":21727.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2874.44,"discounted_cash":2012.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OCRELIZUMAB-HYALURONIDASE-OCSQ INJ 920-23000 MG-UNIT/23ML","drug_information":{"unit":23.0,"type":"ML"},"code_information":[{"code":"Rx50242055401","type":"CDM"},{"code":"J2351","type":"HCPCS"},{"code":"50242055401","type":"NDC"}],"standard_charges":[{"gross_charge":167588.1,"discounted_cash":117311.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":45664.42,"discounted_cash":31965.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006911","type":"CDM"},{"code":"50268006911","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007111","type":"CDM"},{"code":"50268007111","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007115","type":"CDM"},{"code":"50268007115","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.45,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008215","type":"CDM"},{"code":"50268008215","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":36.16,"discounted_cash":25.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268009811","type":"CDM"},{"code":"50268009811","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268009815","type":"CDM"},{"code":"50268009815","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011115","type":"CDM"},{"code":"50268011115","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011415","type":"CDM"},{"code":"50268011415","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014011","type":"CDM"},{"code":"50268014011","type":"NDC"}],"standard_charges":[{"gross_charge":12.19,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014013","type":"CDM"},{"code":"50268014013","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014111","type":"CDM"},{"code":"50268014111","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.48,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014815","type":"CDM"},{"code":"50268014815","type":"NDC"}],"standard_charges":[{"gross_charge":12.53,"discounted_cash":8.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016211","type":"CDM"},{"code":"50268016211","type":"NDC"}],"standard_charges":[{"gross_charge":14.48,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.41,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.34,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268017715","type":"CDM"},{"code":"50268017715","type":"NDC"}],"standard_charges":[{"gross_charge":11.39,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268018711","type":"CDM"},{"code":"50268018711","type":"NDC"}],"standard_charges":[{"gross_charge":17.91,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268021715","type":"CDM"},{"code":"50268021715","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268022011","type":"CDM"},{"code":"50268022011","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268022015","type":"CDM"},{"code":"50268022015","type":"NDC"}],"standard_charges":[{"gross_charge":13.43,"discounted_cash":9.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.03,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268028713","type":"CDM"},{"code":"50268028713","type":"NDC"}],"standard_charges":[{"gross_charge":11.47,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029715","type":"CDM"},{"code":"50268029715","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029811","type":"CDM"},{"code":"50268029811","type":"NDC"}],"standard_charges":[{"gross_charge":18.04,"discounted_cash":12.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029812","type":"CDM"},{"code":"50268029812","type":"NDC"}],"standard_charges":[{"gross_charge":18.34,"discounted_cash":12.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268030311","type":"CDM"},{"code":"50268030311","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268030315","type":"CDM"},{"code":"50268030315","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMCICLOVIR TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268030611","type":"CDM"},{"code":"50268030611","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":10.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMCICLOVIR TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268030613","type":"CDM"},{"code":"50268030613","type":"NDC"}],"standard_charges":[{"gross_charge":12.81,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032111","type":"CDM"},{"code":"50268032111","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032115","type":"CDM"},{"code":"50268032115","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":7.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035011","type":"CDM"},{"code":"50268035011","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268039811","type":"CDM"},{"code":"50268039811","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268039850","type":"CDM"},{"code":"50268039850","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.13,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.81,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043111","type":"CDM"},{"code":"50268043111","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043115","type":"CDM"},{"code":"50268043115","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047715","type":"CDM"},{"code":"50268047715","type":"NDC"}],"standard_charges":[{"gross_charge":14.04,"discounted_cash":9.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048811","type":"CDM"},{"code":"50268048811","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052111","type":"CDM"},{"code":"50268052111","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MECLIZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052211","type":"CDM"},{"code":"50268052211","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MECLIZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052215","type":"CDM"},{"code":"50268052215","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052411","type":"CDM"},{"code":"50268052411","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052415","type":"CDM"},{"code":"50268052415","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053211","type":"CDM"},{"code":"50268053211","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053411","type":"CDM"},{"code":"50268053411","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054215","type":"CDM"},{"code":"50268054215","type":"NDC"}],"standard_charges":[{"gross_charge":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056215","type":"CDM"},{"code":"50268056215","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056711","type":"CDM"},{"code":"50268056711","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056715","type":"CDM"},{"code":"50268056715","type":"NDC"}],"standard_charges":[{"gross_charge":11.13,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057311","type":"CDM"},{"code":"50268057311","type":"NDC"}],"standard_charges":[{"gross_charge":11.17,"discounted_cash":7.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.37,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060315","type":"CDM"},{"code":"50268060315","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060515","type":"CDM"},{"code":"50268060515","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.3,"discounted_cash":9.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061611","type":"CDM"},{"code":"50268061611","type":"NDC"}],"standard_charges":[{"gross_charge":23.04,"discounted_cash":16.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061613","type":"CDM"},{"code":"50268061613","type":"NDC"}],"standard_charges":[{"gross_charge":22.89,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061711","type":"CDM"},{"code":"50268061711","type":"NDC"}],"standard_charges":[{"gross_charge":37.2,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061713","type":"CDM"},{"code":"50268061713","type":"NDC"}],"standard_charges":[{"gross_charge":17.57,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.57,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268064011","type":"CDM"},{"code":"50268064011","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268064015","type":"CDM"},{"code":"50268064015","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068711","type":"CDM"},{"code":"50268068711","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068715","type":"CDM"},{"code":"50268068715","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268069511","type":"CDM"},{"code":"50268069511","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070111","type":"CDM"},{"code":"50268070111","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070115","type":"CDM"},{"code":"50268070115","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070211","type":"CDM"},{"code":"50268070211","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268071715","type":"CDM"},{"code":"50268071715","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.16,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.74,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072811","type":"CDM"},{"code":"50268072811","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072815","type":"CDM"},{"code":"50268072815","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268073015","type":"CDM"},{"code":"50268073015","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.74,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":2.27,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074011","type":"CDM"},{"code":"50268074011","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074015","type":"CDM"},{"code":"50268074015","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074611","type":"CDM"},{"code":"50268074611","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074615","type":"CDM"},{"code":"50268074615","type":"NDC"}],"standard_charges":[{"gross_charge":11.73,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIMETHOPRIM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077511","type":"CDM"},{"code":"50268077511","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIMETHOPRIM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077515","type":"CDM"},{"code":"50268077515","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268080011","type":"CDM"},{"code":"50268080011","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268080015","type":"CDM"},{"code":"50268080015","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268081111","type":"CDM"},{"code":"50268081111","type":"NDC"}],"standard_charges":[{"gross_charge":14.12,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085111","type":"CDM"},{"code":"50268085111","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085115","type":"CDM"},{"code":"50268085115","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085515","type":"CDM"},{"code":"50268085515","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"B-COMPLEX W/BIOTIN & FOLIC ACID TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085711","type":"CDM"},{"code":"50268085711","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"B-COMPLEX W/BIOTIN & FOLIC ACID TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085715","type":"CDM"},{"code":"50268085715","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085911","type":"CDM"},{"code":"50268085911","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085915","type":"CDM"},{"code":"50268085915","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50323000603","type":"CDM"},{"code":"50323000603","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50383002115","type":"CDM"},{"code":"50383002115","type":"NDC"}],"standard_charges":[{"gross_charge":74.72,"discounted_cash":52.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOCARNITINE ORAL SOLN 1 GM/10ML (10%)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx50383017104","type":"CDM"},{"code":"50383017104","type":"NDC"}],"standard_charges":[{"gross_charge":11.46,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOCARNITINE TAB 330 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50383017290","type":"CDM"},{"code":"50383017290","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383023310","type":"CDM"},{"code":"50383023310","type":"NDC"}],"standard_charges":[{"gross_charge":182.62,"discounted_cash":127.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx50383026715","type":"CDM"},{"code":"50383026715","type":"NDC"}],"standard_charges":[{"gross_charge":116.8,"discounted_cash":81.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx50383028202","type":"CDM"},{"code":"50383028202","type":"NDC"}],"standard_charges":[{"gross_charge":74.62,"discounted_cash":52.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx50383031106","type":"CDM"},{"code":"50383031106","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx50383031109","type":"CDM"},{"code":"50383031109","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx50383031147","type":"CDM"},{"code":"50383031147","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE SOLN 75 MG/ML (15 MG/ML ELEMENTAL FE)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx50383062750","type":"CDM"},{"code":"50383062750","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML)","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx50383074120","type":"CDM"},{"code":"J7611","type":"HCPCS"},{"code":"50383074120","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383081016","type":"CDM"},{"code":"50383081016","type":"NDC"}],"standard_charges":[{"gross_charge":16.58,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383082316","type":"CDM"},{"code":"50383082316","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383082416","type":"CDM"},{"code":"50383082416","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383082420","type":"CDM"},{"code":"50383082420","type":"NDC"}],"standard_charges":[{"gross_charge":13.37,"discounted_cash":9.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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: WSH 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":2.0,"type":"ML"},"code_information":[{"code":"Rx50419032507","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032507","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVONORGESTREL RELEASING IUD 14 MCG/DAY (13.5 MG TOTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50419042201","type":"CDM"},{"code":"J7301","type":"HCPCS"},{"code":"50419042201","type":"NDC"}],"standard_charges":[{"gross_charge":1566.09,"discounted_cash":1096.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVONORGESTREL IUD 20 MCG/DAY (INITIAL) (52 MG TOTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50419042301","type":"CDM"},{"code":"J7298","type":"HCPCS"},{"code":"50419042301","type":"NDC"}],"standard_charges":[{"gross_charge":1878.77,"discounted_cash":1315.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVONORGESTREL RELEASING IUD 17.5 MCG/DAY (19.5 MG TOTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50419042401","type":"CDM"},{"code":"J7296","type":"HCPCS"},{"code":"50419042401","type":"NDC"}],"standard_charges":[{"gross_charge":1878.77,"discounted_cash":1315.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx50419077301","type":"CDM"},{"code":"50419077301","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":11.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ITRACONAZOLE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50458029515","type":"CDM"},{"code":"50458029515","type":"NDC"}],"standard_charges":[{"gross_charge":49.31,"discounted_cash":34.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE MICROSPHERES FOR IM EXTENDED REL SUSP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458030611","type":"CDM"},{"code":"J2794","type":"HCPCS"},{"code":"50458030611","type":"NDC"}],"standard_charges":[{"gross_charge":2364.93,"discounted_cash":1655.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE MICROSPHERES FOR IM EXTENDED REL SUSP 37.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458030711","type":"CDM"},{"code":"J2794","type":"HCPCS"},{"code":"50458030711","type":"NDC"}],"standard_charges":[{"gross_charge":3547.56,"discounted_cash":2483.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE MICROSPHERES FOR IM EXTENDED REL SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458030811","type":"CDM"},{"code":"J2794","type":"HCPCS"},{"code":"50458030811","type":"NDC"}],"standard_charges":[{"gross_charge":4731.78,"discounted_cash":3312.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE MICROSPHERES FOR IM EXTENDED REL SUSP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458030911","type":"CDM"},{"code":"J2794","type":"HCPCS"},{"code":"50458030911","type":"NDC"}],"standard_charges":[{"gross_charge":1182.62,"discounted_cash":827.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458031528","type":"CDM"},{"code":"50458031528","type":"NDC"}],"standard_charges":[{"gross_charge":31.55,"discounted_cash":22.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458055001","type":"CDM"},{"code":"50458055001","type":"NDC"}],"standard_charges":[{"gross_charge":31.54,"discounted_cash":22.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458055101","type":"CDM"},{"code":"50458055101","type":"NDC"}],"standard_charges":[{"gross_charge":31.54,"discounted_cash":22.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE PALMITATE ER SUSP PREF SYR 156 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx50458056301","type":"CDM"},{"code":"J2426","type":"HCPCS"},{"code":"50458056301","type":"NDC"}],"standard_charges":[{"gross_charge":8720.67,"discounted_cash":6104.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PALIPERIDONE PALMITATE ER SUSP PREF SYR 234 MG/1.5ML","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx50458056401","type":"CDM"},{"code":"J2426","type":"HCPCS"},{"code":"50458056401","type":"NDC"}],"standard_charges":[{"gross_charge":13080.72,"discounted_cash":9156.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057760","type":"CDM"},{"code":"50458057760","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057890","type":"CDM"},{"code":"50458057890","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVAROXABAN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057901","type":"CDM"},{"code":"50458057901","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVAROXABAN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057910","type":"CDM"},{"code":"50458057910","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVAROXABAN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057930","type":"CDM"},{"code":"50458057930","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 27 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058801","type":"CDM"},{"code":"50458058801","type":"NDC"}],"standard_charges":[{"gross_charge":34.2,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458059010","type":"CDM"},{"code":"50458059010","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458059110","type":"CDM"},{"code":"50458059110","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458059450","type":"CDM"},{"code":"50458059450","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.86,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458060128","type":"CDM"},{"code":"50458060128","type":"NDC"}],"standard_charges":[{"gross_charge":16.98,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458060228","type":"CDM"},{"code":"50458060228","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":12.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458060328","type":"CDM"},{"code":"50458060328","type":"NDC"}],"standard_charges":[{"gross_charge":23.15,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAPENTADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458082002","type":"CDM"},{"code":"50458082002","type":"NDC"}],"standard_charges":[{"gross_charge":21.64,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAPENTADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458082004","type":"CDM"},{"code":"50458082004","type":"NDC"}],"standard_charges":[{"gross_charge":20.73,"discounted_cash":14.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":796.2,"discounted_cash":557.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB ER 12HR 0.375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50532011510","type":"CDM"},{"code":"50532011510","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOPERAMIDE HCL SOLN 1 MG/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx50580013444","type":"CDM"},{"code":"50580013444","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580049698","type":"CDM"},{"code":"50580049698","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50580053501","type":"CDM"},{"code":"50580053501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580060002","type":"CDM"},{"code":"50580060002","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50580060121","type":"CDM"},{"code":"50580060121","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":785.34,"discounted_cash":549.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":5985.7,"discounted_cash":4189.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4783.86,"discounted_cash":3348.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":18607.49,"discounted_cash":13025.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLUCARPIDASE FOR IV INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633021011","type":"CDM"},{"code":"C9293","type":"HCPCS"},{"code":"50633021011","type":"NDC"}],"standard_charges":[{"gross_charge":145126.08,"discounted_cash":101588.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":3732.26,"discounted_cash":2612.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MEXILETINE HCL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742024101","type":"CDM"},{"code":"50742024101","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742034001","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"50742034001","type":"NDC"}],"standard_charges":[{"gross_charge":363.22,"discounted_cash":254.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742034101","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"50742034101","type":"NDC"}],"standard_charges":[{"gross_charge":1579.03,"discounted_cash":1105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IVABRADINE HCL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742036260","type":"CDM"},{"code":"50742036260","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 7.5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742037304","type":"CDM"},{"code":"50742037304","type":"NDC"}],"standard_charges":[{"gross_charge":112.87,"discounted_cash":79.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 15 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742037501","type":"CDM"},{"code":"50742037501","type":"NDC"}],"standard_charges":[{"gross_charge":168.16,"discounted_cash":117.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 15 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742037504","type":"CDM"},{"code":"50742037504","type":"NDC"}],"standard_charges":[{"gross_charge":136.83,"discounted_cash":95.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 20 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742037601","type":"CDM"},{"code":"50742037601","type":"NDC"}],"standard_charges":[{"gross_charge":201.09,"discounted_cash":140.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 20 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742037604","type":"CDM"},{"code":"50742037604","type":"NDC"}],"standard_charges":[{"gross_charge":165.31,"discounted_cash":115.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742039701","type":"CDM"},{"code":"50742039701","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx50742040620","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"50742040620","type":"NDC"}],"standard_charges":[{"gross_charge":303.04,"discounted_cash":212.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":28.11,"discounted_cash":19.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050504","type":"CDM"},{"code":"50742050504","type":"NDC"}],"standard_charges":[{"gross_charge":22.19,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22.29,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.3 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742051501","type":"CDM"},{"code":"50742051501","type":"NDC"}],"standard_charges":[{"gross_charge":28.56,"discounted_cash":19.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.3 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742051530","type":"CDM"},{"code":"50742051530","type":"NDC"}],"standard_charges":[{"gross_charge":100.97,"discounted_cash":70.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":976.21,"discounted_cash":683.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742056401","type":"CDM"},{"code":"50742056401","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx50930009802","type":"CDM"},{"code":"50930009802","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":38.47,"discounted_cash":26.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":40.04,"discounted_cash":28.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002301","type":"CDM"},{"code":"51079002301","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.1,"discounted_cash":11.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079003501","type":"CDM"},{"code":"51079003501","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079004701","type":"CDM"},{"code":"51079004701","type":"NDC"}],"standard_charges":[{"gross_charge":15.77,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079004720","type":"CDM"},{"code":"51079004720","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005101","type":"CDM"},{"code":"51079005101","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005801","type":"CDM"},{"code":"51079005801","type":"NDC"}],"standard_charges":[{"gross_charge":13.23,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079006701","type":"CDM"},{"code":"51079006701","type":"NDC"}],"standard_charges":[{"gross_charge":12.43,"discounted_cash":8.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079006720","type":"CDM"},{"code":"51079006720","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007701","type":"CDM"},{"code":"51079007701","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007720","type":"CDM"},{"code":"51079007720","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008301","type":"CDM"},{"code":"51079008301","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008320","type":"CDM"},{"code":"51079008320","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079009301","type":"CDM"},{"code":"51079009301","type":"NDC"}],"standard_charges":[{"gross_charge":14.08,"discounted_cash":9.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010520","type":"CDM"},{"code":"51079010520","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010701","type":"CDM"},{"code":"51079010701","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079011801","type":"CDM"},{"code":"51079011801","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079011820","type":"CDM"},{"code":"51079011820","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079011901","type":"CDM"},{"code":"51079011901","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICYCLOMINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079011920","type":"CDM"},{"code":"51079011920","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079012601","type":"CDM"},{"code":"51079012601","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079012901","type":"CDM"},{"code":"51079012901","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079012906","type":"CDM"},{"code":"51079012906","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013001","type":"CDM"},{"code":"51079013001","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.38,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.78,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014601","type":"CDM"},{"code":"51079014601","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014620","type":"CDM"},{"code":"51079014620","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014920","type":"CDM"},{"code":"51079014920","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079015101","type":"CDM"},{"code":"51079015101","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079015120","type":"CDM"},{"code":"51079015120","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016401","type":"CDM"},{"code":"51079016401","type":"NDC"}],"standard_charges":[{"gross_charge":23.87,"discounted_cash":16.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016403","type":"CDM"},{"code":"51079016403","type":"NDC"}],"standard_charges":[{"gross_charge":23.55,"discounted_cash":16.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016501","type":"CDM"},{"code":"51079016501","type":"NDC"}],"standard_charges":[{"gross_charge":67.21,"discounted_cash":47.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016503","type":"CDM"},{"code":"51079016503","type":"NDC"}],"standard_charges":[{"gross_charge":66.63,"discounted_cash":46.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017201","type":"CDM"},{"code":"51079017201","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017220","type":"CDM"},{"code":"51079017220","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017301","type":"CDM"},{"code":"51079017301","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017308","type":"CDM"},{"code":"51079017308","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018101","type":"CDM"},{"code":"51079018101","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018201","type":"CDM"},{"code":"51079018201","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018220","type":"CDM"},{"code":"51079018220","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019001","type":"CDM"},{"code":"51079019001","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019020","type":"CDM"},{"code":"51079019020","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019101","type":"CDM"},{"code":"51079019101","type":"NDC"}],"standard_charges":[{"gross_charge":11.39,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":26.92,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019703","type":"CDM"},{"code":"51079019703","type":"NDC"}],"standard_charges":[{"gross_charge":26.92,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019801","type":"CDM"},{"code":"51079019801","type":"NDC"}],"standard_charges":[{"gross_charge":27.64,"discounted_cash":19.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019803","type":"CDM"},{"code":"51079019803","type":"NDC"}],"standard_charges":[{"gross_charge":27.64,"discounted_cash":19.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019901","type":"CDM"},{"code":"51079019901","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019920","type":"CDM"},{"code":"51079019920","type":"NDC"}],"standard_charges":[{"gross_charge":14.17,"discounted_cash":9.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020401","type":"CDM"},{"code":"51079020401","type":"NDC"}],"standard_charges":[{"gross_charge":22.44,"discounted_cash":15.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020406","type":"CDM"},{"code":"51079020406","type":"NDC"}],"standard_charges":[{"gross_charge":24.22,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020601","type":"CDM"},{"code":"51079020601","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020620","type":"CDM"},{"code":"51079020620","type":"NDC"}],"standard_charges":[{"gross_charge":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020920","type":"CDM"},{"code":"51079020920","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021101","type":"CDM"},{"code":"51079021101","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021103","type":"CDM"},{"code":"51079021103","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021701","type":"CDM"},{"code":"51079021701","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079022301","type":"CDM"},{"code":"51079022301","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079022401","type":"CDM"},{"code":"51079022401","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079027301","type":"CDM"},{"code":"51079027301","type":"NDC"}],"standard_charges":[{"gross_charge":17.49,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079027303","type":"CDM"},{"code":"51079027303","type":"NDC"}],"standard_charges":[{"gross_charge":18.22,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079027801","type":"CDM"},{"code":"51079027801","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079027901","type":"CDM"},{"code":"51079027901","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029401","type":"CDM"},{"code":"51079029401","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029420","type":"CDM"},{"code":"51079029420","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029901","type":"CDM"},{"code":"51079029901","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030001","type":"CDM"},{"code":"51079030001","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030601","type":"CDM"},{"code":"51079030601","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079034501","type":"CDM"},{"code":"51079034501","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079034505","type":"CDM"},{"code":"51079034505","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"discounted_cash":9.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079034601","type":"CDM"},{"code":"51079034601","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079034605","type":"CDM"},{"code":"51079034605","type":"NDC"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079035201","type":"CDM"},{"code":"51079035201","type":"NDC"}],"standard_charges":[{"gross_charge":13.1,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079035216","type":"CDM"},{"code":"51079035216","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079035316","type":"CDM"},{"code":"51079035316","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.53,"discounted_cash":8.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.64,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037901","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079037901","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037920","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079037920","type":"NDC"}],"standard_charges":[{"gross_charge":12.03,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038601","type":"CDM"},{"code":"51079038601","type":"NDC"}],"standard_charges":[{"gross_charge":13.23,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038620","type":"CDM"},{"code":"51079038620","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079039101","type":"CDM"},{"code":"51079039101","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079039120","type":"CDM"},{"code":"51079039120","type":"NDC"}],"standard_charges":[{"gross_charge":11.46,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079039201","type":"CDM"},{"code":"51079039201","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079040001","type":"CDM"},{"code":"51079040001","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.84,"discounted_cash":8.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041720","type":"CDM"},{"code":"51079041720","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041801","type":"CDM"},{"code":"51079041801","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041820","type":"CDM"},{"code":"51079041820","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043101","type":"CDM"},{"code":"51079043101","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043120","type":"CDM"},{"code":"51079043120","type":"NDC"}],"standard_charges":[{"gross_charge":12.92,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.27,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXEPIN HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043801","type":"CDM"},{"code":"51079043801","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.22,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":13.35,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045020","type":"CDM"},{"code":"51079045020","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045101","type":"CDM"},{"code":"51079045101","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045201","type":"CDM"},{"code":"51079045201","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.34,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045820","type":"CDM"},{"code":"51079045820","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046001","type":"CDM"},{"code":"51079046001","type":"NDC"}],"standard_charges":[{"gross_charge":17.39,"discounted_cash":12.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046020","type":"CDM"},{"code":"51079046020","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046101","type":"CDM"},{"code":"51079046101","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046120","type":"CDM"},{"code":"51079046120","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046201","type":"CDM"},{"code":"51079046201","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046301","type":"CDM"},{"code":"51079046301","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046320","type":"CDM"},{"code":"51079046320","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046401","type":"CDM"},{"code":"51079046401","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046420","type":"CDM"},{"code":"51079046420","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046601","type":"CDM"},{"code":"51079046601","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046701","type":"CDM"},{"code":"51079046701","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079047501","type":"CDM"},{"code":"51079047501","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":11.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079047508","type":"CDM"},{"code":"51079047508","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048201","type":"CDM"},{"code":"51079048201","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049801","type":"CDM"},{"code":"51079049801","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049820","type":"CDM"},{"code":"51079049820","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049901","type":"CDM"},{"code":"51079049901","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079051820","type":"CDM"},{"code":"51079051820","type":"NDC"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079053801","type":"CDM"},{"code":"51079053801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054201","type":"CDM"},{"code":"51079054201","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054301","type":"CDM"},{"code":"51079054301","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079055720","type":"CDM"},{"code":"51079055720","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079055801","type":"CDM"},{"code":"51079055801","type":"NDC"}],"standard_charges":[{"gross_charge":47.01,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056101","type":"CDM"},{"code":"51079056101","type":"NDC"}],"standard_charges":[{"gross_charge":33.29,"discounted_cash":23.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056103","type":"CDM"},{"code":"51079056103","type":"NDC"}],"standard_charges":[{"gross_charge":28.56,"discounted_cash":19.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056601","type":"CDM"},{"code":"51079056601","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058201","type":"CDM"},{"code":"51079058201","type":"NDC"}],"standard_charges":[{"gross_charge":23.49,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058205","type":"CDM"},{"code":"51079058205","type":"NDC"}],"standard_charges":[{"gross_charge":29.12,"discounted_cash":20.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058501","type":"CDM"},{"code":"51079058501","type":"NDC"}],"standard_charges":[{"gross_charge":14.15,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062006","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"51079062006","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062901","type":"CDM"},{"code":"51079062901","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.45,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063020","type":"CDM"},{"code":"51079063020","type":"NDC"}],"standard_charges":[{"gross_charge":12.59,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PRAZOSIN HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063101","type":"CDM"},{"code":"51079063101","type":"NDC"}],"standard_charges":[{"gross_charge":13.36,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":16.34,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":17.89,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079067001","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"51079067001","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079067005","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"51079067005","type":"NDC"}],"standard_charges":[{"gross_charge":14.67,"discounted_cash":10.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069020","type":"CDM"},{"code":"51079069020","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079070001","type":"CDM"},{"code":"51079070001","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079070020","type":"CDM"},{"code":"51079070020","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.08,"discounted_cash":9.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072220","type":"CDM"},{"code":"51079072220","type":"NDC"}],"standard_charges":[{"gross_charge":13.12,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072601","type":"CDM"},{"code":"51079072601","type":"NDC"}],"standard_charges":[{"gross_charge":14.89,"discounted_cash":10.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072620","type":"CDM"},{"code":"51079072620","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072801","type":"CDM"},{"code":"51079072801","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073620","type":"CDM"},{"code":"51079073620","type":"NDC"}],"standard_charges":[{"gross_charge":11.17,"discounted_cash":7.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074601","type":"CDM"},{"code":"51079074601","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074619","type":"CDM"},{"code":"51079074619","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074620","type":"CDM"},{"code":"51079074620","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074901","type":"CDM"},{"code":"51079074901","type":"NDC"}],"standard_charges":[{"gross_charge":12.51,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074920","type":"CDM"},{"code":"51079074920","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.78,"discounted_cash":8.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076801","type":"CDM"},{"code":"51079076801","type":"NDC"}],"standard_charges":[{"gross_charge":13.81,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076820","type":"CDM"},{"code":"51079076820","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077101","type":"CDM"},{"code":"51079077101","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077120","type":"CDM"},{"code":"51079077120","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077401","type":"CDM"},{"code":"51079077401","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077420","type":"CDM"},{"code":"51079077420","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078901","type":"CDM"},{"code":"51079078901","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078920","type":"CDM"},{"code":"51079078920","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079520","type":"CDM"},{"code":"51079079520","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080117","type":"CDM"},{"code":"51079080117","type":"NDC"}],"standard_charges":[{"gross_charge":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080201","type":"CDM"},{"code":"51079080201","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080220","type":"CDM"},{"code":"51079080220","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080620","type":"CDM"},{"code":"51079080620","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.92,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":19.03,"discounted_cash":13.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079085201","type":"CDM"},{"code":"51079085201","type":"NDC"}],"standard_charges":[{"gross_charge":13.09,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086301","type":"CDM"},{"code":"51079086301","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086801","type":"CDM"},{"code":"51079086801","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086901","type":"CDM"},{"code":"51079086901","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087101","type":"CDM"},{"code":"51079087101","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088601","type":"CDM"},{"code":"51079088601","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088620","type":"CDM"},{"code":"51079088620","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088801","type":"CDM"},{"code":"51079088801","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088819","type":"CDM"},{"code":"51079088819","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.37,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088901","type":"CDM"},{"code":"51079088901","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089401","type":"CDM"},{"code":"51079089401","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089601","type":"CDM"},{"code":"51079089601","type":"NDC"}],"standard_charges":[{"gross_charge":12.59,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089620","type":"CDM"},{"code":"51079089620","type":"NDC"}],"standard_charges":[{"gross_charge":13.44,"discounted_cash":9.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089901","type":"CDM"},{"code":"51079089901","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LOXAPINE SUCCINATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079090201","type":"CDM"},{"code":"51079090201","type":"NDC"}],"standard_charges":[{"gross_charge":13.71,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079090501","type":"CDM"},{"code":"51079090501","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092101","type":"CDM"},{"code":"51079092101","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092120","type":"CDM"},{"code":"51079092120","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092201","type":"CDM"},{"code":"51079092201","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092220","type":"CDM"},{"code":"51079092220","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092301","type":"CDM"},{"code":"51079092301","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092320","type":"CDM"},{"code":"51079092320","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":14.71,"discounted_cash":10.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":15.79,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092501","type":"CDM"},{"code":"51079092501","type":"NDC"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092801","type":"CDM"},{"code":"51079092801","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092901","type":"CDM"},{"code":"51079092901","type":"NDC"}],"standard_charges":[{"gross_charge":11.39,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093201","type":"CDM"},{"code":"51079093201","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093220","type":"CDM"},{"code":"51079093220","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093620","type":"CDM"},{"code":"51079093620","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093820","type":"CDM"},{"code":"51079093820","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094401","type":"CDM"},{"code":"51079094401","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095701","type":"CDM"},{"code":"51079095701","type":"NDC"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095801","type":"CDM"},{"code":"51079095801","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095820","type":"CDM"},{"code":"51079095820","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095901","type":"CDM"},{"code":"51079095901","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079096601","type":"CDM"},{"code":"51079096601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079096620","type":"CDM"},{"code":"51079096620","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097901","type":"CDM"},{"code":"51079097901","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":12.88,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098101","type":"CDM"},{"code":"51079098101","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099101","type":"CDM"},{"code":"51079099101","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099120","type":"CDM"},{"code":"51079099120","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUVOXAMINE MALEATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099201","type":"CDM"},{"code":"51079099201","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099801","type":"CDM"},{"code":"51079099801","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":29160.64,"discounted_cash":20412.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":35174.18,"discounted_cash":24621.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1193.6,"discounted_cash":835.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293080101","type":"CDM"},{"code":"51293080101","type":"NDC"}],"standard_charges":[{"gross_charge":13.1,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293080201","type":"CDM"},{"code":"51293080201","type":"NDC"}],"standard_charges":[{"gross_charge":14.53,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293081001","type":"CDM"},{"code":"51293081001","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51407010730","type":"CDM"},{"code":"51407010730","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51407055801","type":"CDM"},{"code":"51407055801","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51407082701","type":"CDM"},{"code":"51407082701","type":"NDC"}],"standard_charges":[{"gross_charge":13.54,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51407082730","type":"CDM"},{"code":"51407082730","type":"NDC"}],"standard_charges":[{"gross_charge":13.54,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FELBAMATE TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51525043101","type":"CDM"},{"code":"51525043101","type":"NDC"}],"standard_charges":[{"gross_charge":17.53,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FELBAMATE SUSP 600 MG/5ML","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx51525044208","type":"CDM"},{"code":"51525044208","type":"NDC"}],"standard_charges":[{"gross_charge":881.87,"discounted_cash":617.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETIC ACID SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx51552005106","type":"CDM"},{"code":"51552005106","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE & TETRACAINE W/ EPINEPH KIT (COMPOUNDING KIT)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx51552134501","type":"CDM"},{"code":"51552134501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125301","type":"CDM"},{"code":"51672125301","type":"NDC"}],"standard_charges":[{"gross_charge":107.55,"discounted_cash":75.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125801","type":"CDM"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":76.88,"discounted_cash":53.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125901","type":"CDM"},{"code":"51672125901","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":44.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":71.35,"discounted_cash":49.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx51672126705","type":"CDM"},{"code":"51672126705","type":"NDC"}],"standard_charges":[{"gross_charge":221.3,"discounted_cash":154.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672127201","type":"CDM"},{"code":"51672127201","type":"NDC"}],"standard_charges":[{"gross_charge":92.26,"discounted_cash":64.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672128201","type":"CDM"},{"code":"51672128201","type":"NDC"}],"standard_charges":[{"gross_charge":61.5,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672128401","type":"CDM"},{"code":"51672128401","type":"NDC"}],"standard_charges":[{"gross_charge":61.98,"discounted_cash":43.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672128901","type":"CDM"},{"code":"51672128901","type":"NDC"}],"standard_charges":[{"gross_charge":73.86,"discounted_cash":51.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":63.6,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":82.89,"discounted_cash":58.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672200102","type":"CDM"},{"code":"51672200102","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE OINT 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx51672201802","type":"CDM"},{"code":"51672201802","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":4.5,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx51672206902","type":"CDM"},{"code":"51672206902","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LORATADINE ORAL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51672207308","type":"CDM"},{"code":"51672207308","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CETIRIZINE HCL ORAL SOLN 1 MG/ML (5 MG/5ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51672210208","type":"CDM"},{"code":"51672210208","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211602","type":"CDM"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400105","type":"CDM"},{"code":"51672400105","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672401105","type":"CDM"},{"code":"51672401105","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672401106","type":"CDM"},{"code":"51672401106","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672402301","type":"CDM"},{"code":"51672402301","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLORAZEPATE DIPOTASSIUM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672404301","type":"CDM"},{"code":"51672404301","type":"NDC"}],"standard_charges":[{"gross_charge":13.96,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51672404709","type":"CDM"},{"code":"51672404709","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CETIRIZINE HCL ORAL SOLN 1 MG/ML (5 MG/5ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51672407008","type":"CDM"},{"code":"51672407008","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672412401","type":"CDM"},{"code":"51672412401","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672414601","type":"CDM"},{"code":"51672414601","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx51754020301","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754020301","type":"NDC"}],"standard_charges":[{"gross_charge":446.82,"discounted_cash":312.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx51754050001","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"51754050001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx51754050201","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"51754050201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx51754100001","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"51754100001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYSTEINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51754100701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754100701","type":"NDC"}],"standard_charges":[{"gross_charge":1073.09,"discounted_cash":751.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYSTEINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51754100703","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754100703","type":"NDC"}],"standard_charges":[{"gross_charge":1083.53,"discounted_cash":758.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IN NACL 0.9% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx51754102901","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754102901","type":"NDC"}],"standard_charges":[{"gross_charge":470.61,"discounted_cash":329.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx51754420001","type":"CDM"},{"code":"51754420001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51754506001","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"51754506001","type":"NDC"}],"standard_charges":[{"gross_charge":108.69,"discounted_cash":76.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE SUBCUTANEOUS ER SUSP PREF SYR 100 MG/0.28ML","drug_information":{"unit":0.28,"type":"ML"},"code_information":[{"code":"Rx51759052010","type":"CDM"},{"code":"J2799","type":"HCPCS"},{"code":"51759052010","type":"NDC"}],"standard_charges":[{"gross_charge":9135.52,"discounted_cash":6394.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE SUBCUTANEOUS ER SUSP PREF SYR 125 MG/0.35ML","drug_information":{"unit":0.35,"type":"ML"},"code_information":[{"code":"Rx51759063010","type":"CDM"},{"code":"J2799","type":"HCPCS"},{"code":"51759063010","type":"NDC"}],"standard_charges":[{"gross_charge":11419.14,"discounted_cash":7993.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE SUBCUTANEOUS ER SUSP PREF SYR 200 MG/0.56ML","drug_information":{"unit":0.56,"type":"ML"},"code_information":[{"code":"Rx51759085010","type":"CDM"},{"code":"J2799","type":"HCPCS"},{"code":"51759085010","type":"NDC"}],"standard_charges":[{"gross_charge":18270.36,"discounted_cash":12789.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE SUBCUTANEOUS ER SUSP PREF SYR 250 MG/0.7ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx51759096010","type":"CDM"},{"code":"J2799","type":"HCPCS"},{"code":"51759096010","type":"NDC"}],"standard_charges":[{"gross_charge":22838.28,"discounted_cash":15986.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801000901","type":"CDM"},{"code":"51801000901","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801000940","type":"CDM"},{"code":"51801000940","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 500 MCG (0.5 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862000560","type":"CDM"},{"code":"51862000560","type":"NDC"}],"standard_charges":[{"gross_charge":22.27,"discounted_cash":15.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":22.27,"discounted_cash":15.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862009601","type":"CDM"},{"code":"51862009601","type":"NDC"}],"standard_charges":[{"gross_charge":12.49,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862012560","type":"CDM"},{"code":"51862012560","type":"NDC"}],"standard_charges":[{"gross_charge":22.27,"discounted_cash":15.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":37.57,"discounted_cash":26.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862045301","type":"CDM"},{"code":"51862045301","type":"NDC"}],"standard_charges":[{"gross_charge":33.1,"discounted_cash":23.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862045404","type":"CDM"},{"code":"51862045404","type":"NDC"}],"standard_charges":[{"gross_charge":48.95,"discounted_cash":34.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TRIMETHOPRIM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862048601","type":"CDM"},{"code":"51862048601","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991001406","type":"CDM"},{"code":"51991001406","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":239.72,"discounted_cash":167.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXCARBAZEPINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991029301","type":"CDM"},{"code":"51991029301","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FE ASPART GLY-FE FUM-SUCC ACD-C-THREONIC ACD-B12-FA TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991054490","type":"CDM"},{"code":"51991054490","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GRANISETRON HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991073520","type":"CDM"},{"code":"Q0166","type":"HCPCS"},{"code":"51991073520","type":"NDC"}],"standard_charges":[{"gross_charge":16.29,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991079406","type":"CDM"},{"code":"51991079406","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991081701","type":"CDM"},{"code":"51991081701","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991081801","type":"CDM"},{"code":"51991081801","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991083801","type":"CDM"},{"code":"51991083801","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL POWDER 17 GM/SCOOP","drug_information":{"unit":238.0,"type":"GM"},"code_information":[{"code":"Rx51991096158","type":"CDM"},{"code":"51991096158","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":228.77,"discounted_cash":160.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52244044910","type":"CDM"},{"code":"52244044910","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":47.52,"discounted_cash":33.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx52268010101","type":"CDM"},{"code":"52268010101","type":"NDC"}],"standard_charges":[{"gross_charge":25.08,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DEXTROAMPHETAMINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52536050001","type":"CDM"},{"code":"52536050001","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN SUSP 25 MG/5ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx52536060011","type":"CDM"},{"code":"52536060011","type":"NDC"}],"standard_charges":[{"gross_charge":18.61,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx52565000814","type":"CDM"},{"code":"52565000814","type":"NDC"}],"standard_charges":[{"gross_charge":78.45,"discounted_cash":54.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx52565000950","type":"CDM"},{"code":"52565000950","type":"NDC"}],"standard_charges":[{"gross_charge":193.77,"discounted_cash":135.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN SULFATE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx52565009015","type":"CDM"},{"code":"52565009015","type":"NDC"}],"standard_charges":[{"gross_charge":155.59,"discounted_cash":108.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GENTAMICIN SULFATE OINT 0.1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx52565009030","type":"CDM"},{"code":"52565009030","type":"NDC"}],"standard_charges":[{"gross_charge":236.76,"discounted_cash":165.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52565010701","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"52565010701","type":"NDC"}],"standard_charges":[{"gross_charge":349.45,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MELPHALAN HCL FOR INJ 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52609300100","type":"CDM"},{"code":"J9245","type":"HCPCS"},{"code":"52609300100","type":"NDC"}],"standard_charges":[{"gross_charge":1835.26,"discounted_cash":1284.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LISINOPRIL ORAL SOLN 1 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx52652300101","type":"CDM"},{"code":"52652300101","type":"NDC"}],"standard_charges":[{"gross_charge":29.62,"discounted_cash":20.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ENALAPRIL MALEATE ORAL SOLN 1 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx52652400101","type":"CDM"},{"code":"52652400101","type":"NDC"}],"standard_charges":[{"gross_charge":29.51,"discounted_cash":20.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMLODIPINE BENZOATE ORAL SUSP 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx52652500101","type":"CDM"},{"code":"52652500101","type":"NDC"}],"standard_charges":[{"gross_charge":28.39,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BACLOFEN SUSP 25 MG/5ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx52652600101","type":"CDM"},{"code":"52652600101","type":"NDC"}],"standard_charges":[{"gross_charge":20.48,"discounted_cash":14.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZONISAMIDE ORAL SUSP 100 MG/5ML (20 MG/ML)","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx52652800101","type":"CDM"},{"code":"52652800101","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TOPIRAMATE ORAL SOLN 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx52652900101","type":"CDM"},{"code":"52652900101","type":"NDC"}],"standard_charges":[{"gross_charge":12.91,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817061104","type":"CDM"},{"code":"52817061104","type":"NDC"}],"standard_charges":[{"gross_charge":34.19,"discounted_cash":23.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 262 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx53076019836","type":"CDM"},{"code":"53076019836","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx53329016979","type":"CDM"},{"code":"53329016979","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53436008401","type":"CDM"},{"code":"53436008401","type":"NDC"}],"standard_charges":[{"gross_charge":82.87,"discounted_cash":58.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53436008404","type":"CDM"},{"code":"53436008404","type":"NDC"}],"standard_charges":[{"gross_charge":88.99,"discounted_cash":62.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53436008430","type":"CDM"},{"code":"53436008430","type":"NDC"}],"standard_charges":[{"gross_charge":69.14,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489033001","type":"CDM"},{"code":"53489033001","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ESTERIFIED ESTROGENS & METHYLTESTOSTERONE TAB 0.625-1.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746007701","type":"CDM"},{"code":"53746007701","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746019001","type":"CDM"},{"code":"53746019001","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746027101","type":"CDM"},{"code":"53746027101","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746046501","type":"CDM"},{"code":"53746046501","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SPIRONOLACTONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746051501","type":"CDM"},{"code":"53746051501","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIOTEPA FOR INJ 15 MG","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx53964000101","type":"CDM"},{"code":"J9342","type":"HCPCS"},{"code":"53964000101","type":"NDC"}],"standard_charges":[{"gross_charge":5971.28,"discounted_cash":4179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESALAMINE CAP ER 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092018981","type":"CDM"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MESALAMINE CAP ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092019112","type":"CDM"},{"code":"54092019112","type":"NDC"}],"standard_charges":[{"gross_charge":20.52,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 500 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092025245","type":"CDM"},{"code":"54092025245","type":"NDC"}],"standard_charges":[{"gross_charge":30.93,"discounted_cash":21.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 500 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092025290","type":"CDM"},{"code":"54092025290","type":"NDC"}],"standard_charges":[{"gross_charge":30.7,"discounted_cash":21.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092038101","type":"CDM"},{"code":"54092038101","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IDURSULFASE SOLN FOR IV INFUSION 6 MG/3ML (2 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx54092070001","type":"CDM"},{"code":"J1743","type":"HCPCS"},{"code":"54092070001","type":"NDC"}],"standard_charges":[{"gross_charge":13112.1,"discounted_cash":9178.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54162000401","type":"CDM"},{"code":"54162000401","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54162000708","type":"CDM"},{"code":"54162000708","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54162001512","type":"CDM"},{"code":"54162001512","type":"NDC"}],"standard_charges":[{"gross_charge":22.51,"discounted_cash":15.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54162008009","type":"CDM"},{"code":"54162008009","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAMPHOR & MENTHOL LOTION 0.5-0.5%","drug_information":{"unit":222.0,"type":"ML"},"code_information":[{"code":"Rx54162055007","type":"CDM"},{"code":"54162055007","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CAMPHOR & MENTHOL LOTION 0.5-0.5%","drug_information":{"unit":222.0,"type":"ML"},"code_information":[{"code":"Rx54162055009","type":"CDM"},{"code":"54162055009","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1648.64,"discounted_cash":1154.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54288013610","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"54288013610","type":"NDC"}],"standard_charges":[{"gross_charge":246.35,"discounted_cash":172.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54288014201","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"54288014201","type":"NDC"}],"standard_charges":[{"gross_charge":154.24,"discounted_cash":107.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54288014210","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"54288014210","type":"NDC"}],"standard_charges":[{"gross_charge":123.92,"discounted_cash":86.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54288014701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288014701","type":"NDC"}],"standard_charges":[{"gross_charge":1093.04,"discounted_cash":765.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOCARNITINE INJ 200 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54482014701","type":"CDM"},{"code":"J1955","type":"HCPCS"},{"code":"54482014701","type":"NDC"}],"standard_charges":[{"gross_charge":566.51,"discounted_cash":396.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LEVOCARNITINE ORAL SOLN 1 GM/10ML (10%)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx54482014801","type":"CDM"},{"code":"54482014801","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54505033210","type":"CDM"},{"code":"54505033210","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx54569245000","type":"CDM"},{"code":"54569245000","type":"NDC"}],"standard_charges":[{"gross_charge":135.94,"discounted_cash":95.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54569312104","type":"CDM"},{"code":"54569312104","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"DARUNAVIR TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54569636600","type":"CDM"},{"code":"54569636600","type":"NDC"}],"standard_charges":[{"gross_charge":75.36,"discounted_cash":52.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL INHAL AEROSOL SOLN 20-100 MCG/ACT","drug_information":{"unit":4.0,"type":"GM"},"code_information":[{"code":"Rx54569640600","type":"CDM"},{"code":"54569640600","type":"NDC"}],"standard_charges":[{"gross_charge":455.09,"discounted_cash":318.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629005701","type":"CDM"},{"code":"54629005701","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629005801","type":"CDM"},{"code":"54629005801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"B-COMPLEX W/BIOTIN & FOLIC ACID TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629013001","type":"CDM"},{"code":"54629013001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629041120","type":"CDM"},{"code":"54629041120","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (37.5 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629064501","type":"CDM"},{"code":"54629064501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ACETYLCYSTEINE CAP 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629409760","type":"CDM"},{"code":"54629409760","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54643564601","type":"CDM"},{"code":"54643564601","type":"NDC"}],"standard_charges":[{"gross_charge":251.61,"discounted_cash":176.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx54643564700","type":"CDM"},{"code":"54643564700","type":"NDC"}],"standard_charges":[{"gross_charge":1741.67,"discounted_cash":1219.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"MULTIPLE VITAMIN IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx54643786201","type":"CDM"},{"code":"54643786201","type":"NDC"}],"standard_charges":[{"gross_charge":225.93,"discounted_cash":158.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx54758006285","type":"CDM"},{"code":"54758006285","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx54758006289","type":"CDM"},{"code":"54758006289","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"CHOLECALCIFEROL ORAL LIQUID 10 MCG/ML (400 UNIT/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx54838000650","type":"CDM"},{"code":"54838000650","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FERROUS SULFATE SOLN 75 MG/ML (15 MG/ML ELEMENTAL FE)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx54838001150","type":"CDM"},{"code":"54838001150","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"HYDROXYZINE HCL SYRUP 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx54838050280","type":"CDM"},{"code":"54838050280","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE SOLUTION 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx54838051080","type":"CDM"},{"code":"54838051080","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.93,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx54838052340","type":"CDM"},{"code":"54838052340","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"LAMIVUDINE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx54838056670","type":"CDM"},{"code":"54838056670","type":"NDC"}],"standard_charges":[{"gross_charge":16.14,"discounted_cash":11.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54868343700","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"54868343700","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"OLANZAPINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111016630","type":"CDM"},{"code":"55111016630","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111017915","type":"CDM"},{"code":"55111017915","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH 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":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111020781","type":"CDM"},{"code":"55111020781","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSH LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111025660","type":"CDM"},{"code":"55111025660","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":7.49,"setting":"