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5001-47-28","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274821","type":"LOCAL"},{"code":"208834","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274821 = Hospital System Supply Identifier | 208834 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-48","code_information":[{"code":"Sx00-5001-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274805","type":"LOCAL"},{"code":"208818","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274805 = Hospital System Supply Identifier | 208818 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 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5001-51","code_information":[{"code":"Sx00-5001-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274808","type":"LOCAL"},{"code":"208821","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274808 = Hospital System Supply Identifier | 208821 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-52","code_information":[{"code":"Sx00-5001-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274809","type":"LOCAL"},{"code":"208822","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274809 = Hospital System Supply Identifier | 208822 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-53","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274810","type":"LOCAL"},{"code":"208823","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274810 = Hospital System Supply Identifier | 208823 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-53-28","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274823","type":"LOCAL"},{"code":"208836","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274823 = Hospital System Supply Identifier | 208836 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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57X26MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200200","type":"LOCAL"},{"code":"522142","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200200 = Hospital System Supply Identifier | 522142 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X22MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200199","type":"LOCAL"},{"code":"522141","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200199 = Hospital System Supply Identifier | 522141 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-57-28","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274824","type":"LOCAL"},{"code":"208837","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274824 = Hospital System Supply Identifier | 208837 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-57","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274813","type":"LOCAL"},{"code":"208826","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274813 = Hospital System Supply Identifier | 208826 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTIPOLAR","code_information":[{"code":"Sx00-5001-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274814","type":"LOCAL"},{"code":"208827","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274814 = Hospital System Supply Identifier | 208827 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-60","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274815","type":"LOCAL"},{"code":"208828","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274815 = Hospital System Supply Identifier | 208828 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-60-28","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274825","type":"LOCAL"},{"code":"208838","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274825 = Hospital System Supply Identifier | 208838 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X22MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200202","type":"LOCAL"},{"code":"522144","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200202 = Hospital System Supply Identifier | 522144 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X26MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200203","type":"LOCAL"},{"code":"522145","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200203 = Hospital System Supply Identifier | 522145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X32MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200204","type":"LOCAL"},{"code":"522146","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200204 = Hospital System Supply Identifier | 522146 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-62","code_information":[{"code":"Sx00-5001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274816","type":"LOCAL"},{"code":"208829","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274816 = Hospital System Supply Identifier | 208829 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X32MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200206","type":"LOCAL"},{"code":"522148","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200206 = Hospital System Supply Identifier | 522148 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X26MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200205","type":"LOCAL"},{"code":"522147","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200205 = Hospital System Supply Identifier | 522147 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-64-28","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"274826","type":"LOCAL"},{"code":"208839","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 274826 = Hospital System Supply Identifier | 208839 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 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68X26MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200209","type":"LOCAL"},{"code":"522151","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200209 = Hospital System Supply Identifier | 522151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X32MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200210","type":"LOCAL"},{"code":"522152","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200210 = Hospital System Supply Identifier | 522152 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200211","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200211 = Hospital System Supply Identifier | 522153 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X32MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"200214","type":"LOCAL"},{"code":"522156","type":"LOCAL"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":1394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 200214 = Hospital System Supply Identifier | 522156 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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60MM","code_information":[{"code":"Sx00-7053-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"118399","type":"LOCAL"},{"code":"210141","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 118399 = Hospital System Supply Identifier | 210141 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 60MM","code_information":[{"code":"Sx00-7053-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"88272","type":"LOCAL"},{"code":"210145","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 88272 = Hospital System Supply Identifier | 210145 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 62MM","code_information":[{"code":"Sx00-7053-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"79678","type":"LOCAL"},{"code":"310991","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 79678 = Hospital System Supply Identifier | 310991 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 62MM","code_information":[{"code":"Sx00-7053-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"79680","type":"LOCAL"},{"code":"310998","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 79680 = Hospital System Supply Identifier | 310998 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"101041","type":"LOCAL"},{"code":"210146","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 101041 = Hospital System Supply Identifier | 210146 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"79426","type":"LOCAL"},{"code":"210147","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 79426 = Hospital System Supply Identifier | 210147 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 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68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"219569","type":"LOCAL"},{"code":"310993","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 219569 = Hospital System Supply Identifier | 310993 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"219573","type":"LOCAL"},{"code":"311000","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 219573 = Hospital System Supply Identifier | 311000 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"221107","type":"LOCAL"},{"code":"361331","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 221107 = Hospital System Supply Identifier | 361331 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"221109","type":"LOCAL"},{"code":"361333","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 221109 = Hospital System Supply Identifier | 361333 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"221108","type":"LOCAL"},{"code":"361332","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 221108 = Hospital System Supply Identifier | 361332 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"221110","type":"LOCAL"},{"code":"361334","type":"LOCAL"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":3494.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 221110 = Hospital System Supply Identifier | 361334 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 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28X52MM","code_information":[{"code":"Sx00-7105-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222832","type":"LOCAL"},{"code":"443655","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222832 = Hospital System Supply Identifier | 443655 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X54MM","code_information":[{"code":"Sx00-7105-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222987","type":"LOCAL"},{"code":"452182","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222987 = Hospital System Supply Identifier | 452182 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 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58X28","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216001","type":"LOCAL"},{"code":"534145","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216001 = Hospital System Supply Identifier | 534145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 58X32","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216002","type":"LOCAL"},{"code":"534146","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216002 = Hospital System Supply Identifier | 534146 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X28","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216003","type":"LOCAL"},{"code":"534147","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216003 = Hospital System Supply Identifier | 534147 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X36","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216004","type":"LOCAL"},{"code":"534148","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216004 = Hospital System Supply Identifier | 534148 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X60MM","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222831","type":"LOCAL"},{"code":"443654","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222831 = Hospital System Supply Identifier | 443654 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 40X62MM","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222830","type":"LOCAL"},{"code":"443652","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222830 = Hospital System Supply Identifier | 443652 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X28","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216005","type":"LOCAL"},{"code":"534149","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216005 = Hospital System Supply Identifier | 534149 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X32","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216006","type":"LOCAL"},{"code":"534150","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216006 = Hospital System Supply Identifier | 534150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 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40X66-70","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222986","type":"LOCAL"},{"code":"452181","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222986 = Hospital System Supply Identifier | 452181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X28","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216008","type":"LOCAL"},{"code":"534152","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216008 = Hospital System Supply Identifier | 534152 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 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72/74X32","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216012","type":"LOCAL"},{"code":"534156","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216012 = Hospital System Supply Identifier | 534156 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X28","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216015","type":"LOCAL"},{"code":"534159","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216015 = Hospital System Supply Identifier | 534159 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X32","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216016","type":"LOCAL"},{"code":"534160","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216016 = Hospital System Supply Identifier | 534160 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X36","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216017","type":"LOCAL"},{"code":"534161","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216017 = Hospital System Supply Identifier | 534161 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X40","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216018","type":"LOCAL"},{"code":"534162","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216018 = Hospital System Supply Identifier | 534162 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 48X28","code_information":[{"code":"Sx00-7110-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216019","type":"LOCAL"},{"code":"534163","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216019 = Hospital System Supply Identifier | 534163 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 50X28","code_information":[{"code":"Sx00-7110-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216020","type":"LOCAL"},{"code":"534164","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216020 = Hospital System Supply Identifier | 534164 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 52X28","code_information":[{"code":"Sx00-7110-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216021","type":"LOCAL"},{"code":"534165","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216021 = Hospital System Supply Identifier | 534165 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 54X28","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216022","type":"LOCAL"},{"code":"534166","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216022 = Hospital System Supply Identifier | 534166 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 32X54MM","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222990","type":"LOCAL"},{"code":"452194","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222990 = Hospital System Supply Identifier | 452194 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X28","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216023","type":"LOCAL"},{"code":"534167","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216023 = Hospital System Supply Identifier | 534167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X32","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216024","type":"LOCAL"},{"code":"534168","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216024 = Hospital System Supply Identifier | 534168 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X32","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216026","type":"LOCAL"},{"code":"534170","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216026 = Hospital System Supply Identifier | 534170 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY 58X36","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222992","type":"LOCAL"},{"code":"452196","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222992 = Hospital System Supply Identifier | 452196 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X28","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216025","type":"LOCAL"},{"code":"534169","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216025 = Hospital System Supply Identifier | 534169 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X28","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216027","type":"LOCAL"},{"code":"534171","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216027 = Hospital System Supply Identifier | 534171 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216031","type":"LOCAL"},{"code":"534175","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216031 = Hospital System Supply Identifier | 534175 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216030","type":"LOCAL"},{"code":"534174","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216030 = Hospital System Supply Identifier | 534174 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40X62/64","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222991","type":"LOCAL"},{"code":"452195","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222991 = Hospital System Supply Identifier | 452195 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62/64X28","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216029","type":"LOCAL"},{"code":"534173","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216029 = Hospital System Supply Identifier | 534173 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40MM","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"220733","type":"LOCAL"},{"code":"360636","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 220733 = Hospital System Supply Identifier | 360636 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 36X62/64","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222994","type":"LOCAL"},{"code":"452198","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222994 = Hospital System Supply Identifier | 452198 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X28","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216032","type":"LOCAL"},{"code":"534176","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216032 = Hospital System Supply Identifier | 534176 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X32","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216033","type":"LOCAL"},{"code":"534177","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216033 = Hospital System Supply Identifier | 534177 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X28","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216034","type":"LOCAL"},{"code":"534178","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216034 = Hospital System Supply Identifier | 534178 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X32","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216035","type":"LOCAL"},{"code":"534179","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216035 = Hospital System Supply Identifier | 534179 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X36","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216036","type":"LOCAL"},{"code":"534180","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216036 = Hospital System Supply Identifier | 534180 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X40","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216037","type":"LOCAL"},{"code":"534181","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216037 = Hospital System Supply Identifier | 534181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X28","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216038","type":"LOCAL"},{"code":"534182","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216038 = Hospital System Supply Identifier | 534182 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X32","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216039","type":"LOCAL"},{"code":"534183","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216039 = Hospital System Supply Identifier | 534183 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X36","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216040","type":"LOCAL"},{"code":"534184","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216040 = Hospital System Supply Identifier | 534184 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X40","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216041","type":"LOCAL"},{"code":"534185","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216041 = Hospital System Supply Identifier | 534185 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 28X50MM","code_information":[{"code":"Sx00-7115-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"221765","type":"LOCAL"},{"code":"408185","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 221765 = Hospital System Supply Identifier | 408185 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 52X28","code_information":[{"code":"Sx00-7115-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216042","type":"LOCAL"},{"code":"534186","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216042 = Hospital System Supply Identifier | 534186 = Lawson ID"}]},{"description":"IMP HIP LNR CNSTRN CEM 54X32MM","code_information":[{"code":"Sx00-7115-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222829","type":"LOCAL"},{"code":"443651","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222829 = Hospital System Supply Identifier | 443651 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 56X32","code_information":[{"code":"Sx00-7115-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216043","type":"LOCAL"},{"code":"534187","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216043 = Hospital System Supply Identifier | 534187 = Lawson ID"}]},{"description":"IMP HIP LNR CNSTRN CEM 36X58MM","code_information":[{"code":"Sx00-7115-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"222988","type":"LOCAL"},{"code":"452184","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 222988 = Hospital System Supply Identifier | 452184 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 60X36","code_information":[{"code":"Sx00-7115-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216044","type":"LOCAL"},{"code":"534188","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216044 = Hospital System Supply Identifier | 534188 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 62-64X36","code_information":[{"code":"Sx00-7115-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"220734","type":"LOCAL"},{"code":"360637","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 220734 = Hospital System Supply Identifier | 360637 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 66/68/70X36","code_information":[{"code":"Sx00-7115-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216045","type":"LOCAL"},{"code":"534189","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216045 = Hospital System Supply Identifier | 534189 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 72/74X36","code_information":[{"code":"Sx00-7115-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216046","type":"LOCAL"},{"code":"534190","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216046 = Hospital System Supply Identifier | 534190 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 76/78/80X36","code_information":[{"code":"Sx00-7115-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216047","type":"LOCAL"},{"code":"534191","type":"LOCAL"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216047 = Hospital System Supply Identifier | 534191 = Lawson ID"}]},{"description":"IMP ACET CAGE SHRT FLG RT","code_information":[{"code":"Sx00-7123-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"221900","type":"LOCAL"},{"code":"409658","type":"LOCAL"}],"standard_charges":[{"gross_charge":10062.5,"discounted_cash":7848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 221900 = Hospital System Supply Identifier | 409658 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT RT 62/64","code_information":[{"code":"Sx00-7123-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216889","type":"LOCAL"},{"code":"534909","type":"LOCAL"}],"standard_charges":[{"gross_charge":10062.5,"discounted_cash":7848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216889 = Hospital System Supply Identifier | 534909 = Lawson ID"}]},{"description":"IMP HIP ACET CAGE 55-66","code_information":[{"code":"Sx00-7123-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"221766","type":"LOCAL"},{"code":"408186","type":"LOCAL"}],"standard_charges":[{"gross_charge":10062.5,"discounted_cash":7848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 221766 = Hospital System Supply Identifier | 408186 = Lawson ID"}]},{"description":"IMP ACET CAGE TRBC RT 72-74","code_information":[{"code":"Sx00-7123-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"220735","type":"LOCAL"},{"code":"360638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10062.5,"discounted_cash":7848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 220735 = Hospital System Supply Identifier | 360638 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT RT 76/78/80","code_information":[{"code":"Sx00-7123-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216890","type":"LOCAL"},{"code":"534910","type":"LOCAL"}],"standard_charges":[{"gross_charge":10062.5,"discounted_cash":7848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216890 = Hospital System Supply Identifier | 534910 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 56/58/60","code_information":[{"code":"Sx00-7124-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"216892","type":"LOCAL"},{"code":"534911","type":"LOCAL"}],"standard_charges":[{"gross_charge":10062.5,"discounted_cash":7848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 216892 = Hospital System Supply Identifier | 534911 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 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BX/55","code_information":[{"code":"Sx00000004261","type":"CDM"},{"code":"272","type":"RC"},{"code":"569451","type":"LOCAL"},{"code":"775108","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569451 = Hospital System Supply Identifier | 775108 = Lawson ID"}]},{"description":"SET PROC BX/125","code_information":[{"code":"Sx00000004262","type":"CDM"},{"code":"272","type":"RC"},{"code":"569452","type":"LOCAL"},{"code":"775109","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569452 = Hospital System Supply Identifier | 775109 = Lawson ID"}]},{"description":"SET PROC BX/175","code_information":[{"code":"Sx00000004263","type":"CDM"},{"code":"272","type":"RC"},{"code":"569453","type":"LOCAL"},{"code":"775110","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569453 = Hospital System Supply Identifier | 775110 = Lawson ID"}]},{"description":"SET PROC BX/225","code_information":[{"code":"Sx00000004264","type":"CDM"},{"code":"272","type":"RC"},{"code":"569454","type":"LOCAL"},{"code":"775111","type":"LOCAL"}],"standard_charges":[{"gross_charge":1596.44,"discounted_cash":1245.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569454 = Hospital System Supply Identifier | 775111 = Lawson ID"}]},{"description":"SET COLL BX","code_information":[{"code":"Sx00000004265","type":"CDM"},{"code":"272","type":"RC"},{"code":"569455","type":"LOCAL"},{"code":"775112","type":"LOCAL"}],"standard_charges":[{"gross_charge":726.07,"discounted_cash":566.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569455 = Hospital System Supply Identifier | 775112 = Lawson ID"}]},{"description":"SET COLL TX CARDIO","code_information":[{"code":"Sx00000004266","type":"CDM"},{"code":"272","type":"RC"},{"code":"569456","type":"LOCAL"},{"code":"775113","type":"LOCAL"}],"standard_charges":[{"gross_charge":737.6,"discounted_cash":575.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569456 = Hospital System Supply Identifier | 775113 = Lawson ID"}]},{"description":"SET COLL BX CARDIO","code_information":[{"code":"Sx00000004267","type":"CDM"},{"code":"272","type":"RC"},{"code":"569457","type":"LOCAL"},{"code":"775114","type":"LOCAL"}],"standard_charges":[{"gross_charge":737.6,"discounted_cash":575.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569457 = Hospital System Supply Identifier | 775114 = Lawson ID"}]},{"description":"HOLDER RESERVOIR PERFUSION CARDIOTOMY BLOOD COLLECTION XRES 04272","code_information":[{"code":"Sx00000004272","type":"CDM"},{"code":"272","type":"RC"},{"code":"887422","type":"LOCAL"},{"code":"1104783","type":"LOCAL"}],"standard_charges":[{"gross_charge":6912.71,"discounted_cash":5391.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887422 = Hospital System Supply Identifier | 1104783 = Lawson ID"}]},{"description":"RESERVOIR BLD COLL XRES B 120","code_information":[{"code":"Sx00000004275","type":"CDM"},{"code":"272","type":"RC"},{"code":"569459","type":"LOCAL"},{"code":"775116","type":"LOCAL"}],"standard_charges":[{"gross_charge":501.84,"discounted_cash":391.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569459 = Hospital System Supply Identifier | 775116 = Lawson ID"}]},{"description":"SET COLL BX CARDIO 120UM","code_information":[{"code":"Sx00000004277","type":"CDM"},{"code":"272","type":"RC"},{"code":"569460","type":"LOCAL"},{"code":"775117","type":"LOCAL"}],"standard_charges":[{"gross_charge":847.13,"discounted_cash":660.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569460 = Hospital System Supply Identifier | 775117 = Lawson ID"}]},{"description":"SET PROC BX/225 120UM","code_information":[{"code":"Sx00000004278","type":"CDM"},{"code":"272","type":"RC"},{"code":"569461","type":"LOCAL"},{"code":"775118","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 569461 = Hospital System Supply Identifier | 775118 = Lawson ID"}]},{"description":"DISC - CATH IMPELLA RP","code_information":[{"code":"Sx00000004334","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"425590","type":"LOCAL"},{"code":"595771","type":"LOCAL"}],"standard_charges":[{"gross_charge":52500.0,"discounted_cash":40950.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 425590 = Hospital System Supply Identifier | 595771 = Lawson ID"}]},{"description":"LEAD SNSE AIRWAY UPPER INSPIRE","code_information":[{"code":"Sx00000004340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"687667","type":"LOCAL"},{"code":"726033","type":"LOCAL"}],"standard_charges":[{"gross_charge":15356.25,"discounted_cash":11977.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 687667 = Hospital System Supply Identifier | 726033 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION MINIMAL BLEEDING SM XTRA 04350 55ML","code_information":[{"code":"Sx00000004350","type":"CDM"},{"code":"272","type":"RC"},{"code":"887412","type":"LOCAL"},{"code":"1104690","type":"LOCAL"}],"standard_charges":[{"gross_charge":984.05,"discounted_cash":767.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887412 = Hospital System Supply Identifier | 1104690 = Lawson ID"}]},{"description":"BARRIER ADH INTERCEED 3X4IN","code_information":[{"code":"Sx00000004350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"261535","type":"LOCAL"},{"code":"104075","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.35,"discounted_cash":3195.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 261535 = Hospital System Supply Identifier | 104075 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION LOW BLEEDING STD CELL XTRA 04351 125ML","code_information":[{"code":"Sx00000004351","type":"CDM"},{"code":"272","type":"RC"},{"code":"887407","type":"LOCAL"},{"code":"1104668","type":"LOCAL"}],"standard_charges":[{"gross_charge":984.05,"discounted_cash":767.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887407 = Hospital System Supply Identifier | 1104668 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION MEDIUM BLEEDING INTMED XTRA 04352 175ML","code_information":[{"code":"Sx00000004352","type":"CDM"},{"code":"272","type":"RC"},{"code":"887417","type":"LOCAL"},{"code":"1104747","type":"LOCAL"}],"standard_charges":[{"gross_charge":984.05,"discounted_cash":767.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887417 = Hospital System Supply Identifier | 1104747 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION HIGH BLEEDING LARGEST XTRA 04353 225ML","code_information":[{"code":"Sx00000004353","type":"CDM"},{"code":"272","type":"RC"},{"code":"887411","type":"LOCAL"},{"code":"1104687","type":"LOCAL"}],"standard_charges":[{"gross_charge":984.05,"discounted_cash":767.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887411 = Hospital System Supply Identifier | 1104687 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04354 55ML","code_information":[{"code":"Sx00000004354","type":"CDM"},{"code":"272","type":"RC"},{"code":"887418","type":"LOCAL"},{"code":"1104748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887418 = Hospital System Supply Identifier | 1104748 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04355 125ML","code_information":[{"code":"Sx00000004355","type":"CDM"},{"code":"272","type":"RC"},{"code":"887423","type":"LOCAL"},{"code":"1104808","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887423 = Hospital System Supply Identifier | 1104808 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04356 175ML","code_information":[{"code":"Sx00000004356","type":"CDM"},{"code":"272","type":"RC"},{"code":"887414","type":"LOCAL"},{"code":"1104721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887414 = Hospital System Supply Identifier | 1104721 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04357 225ML","code_information":[{"code":"Sx00000004357","type":"CDM"},{"code":"272","type":"RC"},{"code":"887421","type":"LOCAL"},{"code":"1104780","type":"LOCAL"}],"standard_charges":[{"gross_charge":1566.57,"discounted_cash":1221.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887421 = Hospital System Supply Identifier | 1104780 = Lawson ID"}]},{"description":"RESERVOIR PERFUSION CARDIOTOMY TOP OUTLET BLOOD XTRA XRES 04358","code_information":[{"code":"Sx00000004358","type":"CDM"},{"code":"272","type":"RC"},{"code":"887413","type":"LOCAL"},{"code":"1104700","type":"LOCAL"}],"standard_charges":[{"gross_charge":480.17,"discounted_cash":374.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887413 = Hospital System Supply Identifier | 1104700 = Lawson ID"}]},{"description":"RESERVOIR PERFUSION CARDIOTOMY BOTTOM OUTLET BLOOD XTRA XRES 04359","code_information":[{"code":"Sx00000004359","type":"CDM"},{"code":"272","type":"RC"},{"code":"887425","type":"LOCAL"},{"code":"1104818","type":"LOCAL"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":359.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887425 = Hospital System Supply Identifier | 1104818 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION TX XTRA 04360","code_information":[{"code":"Sx00000004360","type":"CDM"},{"code":"272","type":"RC"},{"code":"887419","type":"LOCAL"},{"code":"1104756","type":"LOCAL"}],"standard_charges":[{"gross_charge":726.07,"discounted_cash":566.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887419 = Hospital System Supply Identifier | 1104756 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04361 55ML","code_information":[{"code":"Sx00000004361","type":"CDM"},{"code":"272","type":"RC"},{"code":"887410","type":"LOCAL"},{"code":"1104681","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887410 = Hospital System Supply Identifier | 1104681 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04362 125ML","code_information":[{"code":"Sx00000004362","type":"CDM"},{"code":"272","type":"RC"},{"code":"887399","type":"LOCAL"},{"code":"1104630","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887399 = Hospital System Supply Identifier | 1104630 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04363 175ML","code_information":[{"code":"Sx00000004363","type":"CDM"},{"code":"272","type":"RC"},{"code":"887406","type":"LOCAL"},{"code":"1104667","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887406 = Hospital System Supply Identifier | 1104667 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04364 225ML","code_information":[{"code":"Sx00000004364","type":"CDM"},{"code":"272","type":"RC"},{"code":"887428","type":"LOCAL"},{"code":"1104832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1596.44,"discounted_cash":1245.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887428 = Hospital System Supply Identifier | 1104832 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION BX XTRA 04365","code_information":[{"code":"Sx00000004365","type":"CDM"},{"code":"272","type":"RC"},{"code":"887420","type":"LOCAL"},{"code":"1104779","type":"LOCAL"}],"standard_charges":[{"gross_charge":726.07,"discounted_cash":566.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887420 = Hospital System Supply Identifier | 1104779 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION TX CARDIO XTRA 04366","code_information":[{"code":"Sx00000004366","type":"CDM"},{"code":"272","type":"RC"},{"code":"887402","type":"LOCAL"},{"code":"1104794","type":"LOCAL"}],"standard_charges":[{"gross_charge":737.6,"discounted_cash":575.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887402 = Hospital System Supply Identifier | 1104794 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION BX CARDIO XTRA 04367","code_information":[{"code":"Sx00000004367","type":"CDM"},{"code":"272","type":"RC"},{"code":"887416","type":"LOCAL"},{"code":"1104745","type":"LOCAL"}],"standard_charges":[{"gross_charge":737.6,"discounted_cash":575.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887416 = Hospital System Supply Identifier | 1104745 = Lawson ID"}]},{"description":"BAG CORONARY PERFUSION WASTE WB10 XTRA 04369 10L","code_information":[{"code":"Sx00000004369","type":"CDM"},{"code":"272","type":"RC"},{"code":"887427","type":"LOCAL"},{"code":"1104827","type":"LOCAL"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":359.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887427 = Hospital System Supply Identifier | 1104827 = Lawson ID"}]},{"description":"RESERVOIR SET CORONARY PERFUSION B BLOOD XTRA XRES 04375 120UM","code_information":[{"code":"Sx00000004375","type":"CDM"},{"code":"272","type":"RC"},{"code":"887405","type":"LOCAL"},{"code":"1104645","type":"LOCAL"}],"standard_charges":[{"gross_charge":501.84,"discounted_cash":391.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887405 = Hospital System Supply Identifier | 1104645 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION B GROSS FILTER XTRA 04376 120UM","code_information":[{"code":"Sx00000004376","type":"CDM"},{"code":"272","type":"RC"},{"code":"887404","type":"LOCAL"},{"code":"1104625","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.45,"discounted_cash":880.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887404 = Hospital System Supply Identifier | 1104625 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION B CARDIO GROSS XTRA 04377 120UM","code_information":[{"code":"Sx00000004377","type":"CDM"},{"code":"272","type":"RC"},{"code":"887401","type":"LOCAL"},{"code":"1104743","type":"LOCAL"}],"standard_charges":[{"gross_charge":847.13,"discounted_cash":660.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887401 = Hospital System Supply Identifier | 1104743 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX 225 GROSS XTRA 04378 225MLX120UM","code_information":[{"code":"Sx00000004378","type":"CDM"},{"code":"272","type":"RC"},{"code":"887415","type":"LOCAL"},{"code":"1104733","type":"LOCAL"}],"standard_charges":[{"gross_charge":1694.17,"discounted_cash":1321.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 887415 = Hospital System Supply Identifier | 1104733 = Lawson ID"}]},{"description":"GUIDE STABILIZING TEND F/RCR","code_information":[{"code":"Sx00000004402","type":"CDM"},{"code":"272","type":"RC"},{"code":"474238","type":"LOCAL"},{"code":"688373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1261.29,"discounted_cash":983.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 474238 = Hospital System Supply Identifier | 688373 = Lawson ID"}]},{"description":"LD/ADPT IS1 BP TO LV1 BP 17CM","code_information":[{"code":"Sx00000004402","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"435051","type":"LOCAL"},{"code":"682750","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 435051 = Hospital System Supply Identifier | 682750 = Lawson ID"}]},{"description":"LD/ADP LV-1 BP TO IS-1 BP 17CM","code_information":[{"code":"Sx00000004403","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"434813","type":"LOCAL"},{"code":"320541","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 434813 = Hospital System Supply Identifier | 320541 = Lawson ID"}]},{"description":"ANCHORS BONE WITH ARTHOSCOPIC","code_information":[{"code":"Sx00000004403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"664212","type":"LOCAL"},{"code":"802646","type":"LOCAL"}],"standard_charges":[{"gross_charge":6419.0,"discounted_cash":5006.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 664212 = Hospital System Supply Identifier | 802646 = Lawson ID"}]},{"description":"ANCHR BONE 3 W/ ADV DELY SYS","code_information":[{"code":"Sx00000004403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"591700","type":"LOCAL"},{"code":"838520","type":"LOCAL"}],"standard_charges":[{"gross_charge":6419.0,"discounted_cash":5006.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 591700 = Hospital System Supply Identifier | 838520 = Lawson ID"}]},{"description":"OFF CONTRACT - RAIL END ADPT XS","code_information":[{"code":"Sx00000004410","type":"CDM"},{"code":"272","type":"RC"},{"code":"549963","type":"LOCAL"},{"code":"757452","type":"LOCAL"}],"standard_charges":[{"gross_charge":2234.1,"discounted_cash":1742.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 549963 = Hospital System Supply Identifier | 757452 = Lawson ID"}]},{"description":"DISC - RAIL 10CM XS","code_information":[{"code":"Sx00000004411","type":"CDM"},{"code":"272","type":"RC"},{"code":"549969","type":"LOCAL"},{"code":"757458","type":"LOCAL"}],"standard_charges":[{"gross_charge":5202.0,"discounted_cash":4057.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 549969 = Hospital System Supply Identifier | 757458 = Lawson ID"}]},{"description":"DISC - RAIL 15CM XS","code_information":[{"code":"Sx00000004416","type":"CDM"},{"code":"272","type":"RC"},{"code":"549970","type":"LOCAL"},{"code":"757459","type":"LOCAL"}],"standard_charges":[{"gross_charge":5819.1,"discounted_cash":4538.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 549970 = Hospital System Supply Identifier | 757459 = Lawson ID"}]},{"description":"DISC - RAIL 20CM XS","code_information":[{"code":"Sx00000004421","type":"CDM"},{"code":"272","type":"RC"},{"code":"549971","type":"LOCAL"},{"code":"757460","type":"LOCAL"}],"standard_charges":[{"gross_charge":6747.3,"discounted_cash":5262.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 549971 = Hospital System Supply Identifier | 757460 = Lawson ID"}]},{"description":"DISC - RAIL 25CM XS","code_information":[{"code":"Sx00000004426","type":"CDM"},{"code":"272","type":"RC"},{"code":"549972","type":"LOCAL"},{"code":"757461","type":"LOCAL"}],"standard_charges":[{"gross_charge":6897.0,"discounted_cash":5379.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 549972 = Hospital System Supply Identifier | 757461 = Lawson ID"}]},{"description":"OFF CONTRACT - RAIL SM 4MM SNGL XS","code_information":[{"code":"Sx00000004440","type":"CDM"},{"code":"272","type":"RC"},{"code":"549964","type":"LOCAL"},{"code":"757453","type":"LOCAL"}],"standard_charges":[{"gross_charge":5140.8,"discounted_cash":4009.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: ASE LOCATION | 549964 = Hospital System Supply Identifier | 757453 = Lawson ID"}]},{"description":"OFF CONTRACT - RAIL LG 6MM SNGL 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