{"hospital_name":"Providence Health and Services - Oregon","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence Seaside Hospital"],"hospital_address":["725 S Wahanna Rd, Seaside, OR 97138"],"license_information":{"license_number":"14-1231","state":"OR"},"type_2_npi":["1578500492","1558435362"],"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":"Sheila Waldron"},"financial_aid_policy":["25% off of standard gross charges."],"standard_charge_information":[{"description":"HC HEMOCONCENTRATOR HPH400TS","code_information":[{"code":"Px0000101088L","type":"CDM"}],"standard_charges":[{"gross_charge":305.3,"discounted_cash":228.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP 18GAX10 MC1810","code_information":[{"code":"Px0000101281L","type":"CDM"}],"standard_charges":[{"gross_charge":83.03,"discounted_cash":62.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MAXCORE INST BX 14GX10CM MC1410","code_information":[{"code":"Px0000101283L","type":"CDM"}],"standard_charges":[{"gross_charge":82.69,"discounted_cash":62.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET MINICAP EXT LIFE PD TRANS 5C4482","code_information":[{"code":"Px0000101371L","type":"CDM"}],"standard_charges":[{"gross_charge":193.82,"discounted_cash":145.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTERCEED 3X4 4350 CDM","code_information":[{"code":"Px0000104075L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.7,"discounted_cash":999.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET PNEUMOTHORAX G03301","code_information":[{"code":"Px0000105784L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.09,"discounted_cash":450.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CHEST PERC 28FR G04226","code_information":[{"code":"Px0000105884L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.96,"discounted_cash":425.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTATIC SURGICEL 2X3 1953","code_information":[{"code":"Px0000106030L","type":"CDM"}],"standard_charges":[{"gross_charge":221.88,"discounted_cash":166.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTAT SURGCEL 2X14IN 1951","code_information":[{"code":"Px0000106034L","type":"CDM"}],"standard_charges":[{"gross_charge":377.99,"discounted_cash":283.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTATIC SURGICEL 4X8 1952","code_information":[{"code":"Px0000106035L","type":"CDM"}],"standard_charges":[{"gross_charge":263.1,"discounted_cash":197.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT LUMBAR CATHETER ACCESSORY 910121","code_information":[{"code":"Px0000106040L","type":"CDM"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CATH SUPRAPUBIC BARD 12FR 143112","code_information":[{"code":"Px0000109527L","type":"CDM"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE MINNESOTA 0092220","code_information":[{"code":"Px0000109716L","type":"CDM"}],"standard_charges":[{"gross_charge":899.0,"discounted_cash":674.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE .035 X 68CM AW14735","code_information":[{"code":"Px0000112720L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.85,"discounted_cash":21.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 18FR 025018","code_information":[{"code":"Px0000114857L","type":"CDM"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":474.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC OLCOTT TORQUE DEVICE PIN VISE G13811","code_information":[{"code":"Px0000114971L","type":"CDM"}],"standard_charges":[{"gross_charge":31.63,"discounted_cash":23.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG .018X180CM GR1806","code_information":[{"code":"Px0000115448L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.01,"discounted_cash":125.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE BENTSON .035 145CM G00691","code_information":[{"code":"Px0000115848L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH GLIDE ANG TAPER 5FR 65CM CG507","code_information":[{"code":"Px0000117231L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.38,"discounted_cash":78.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACCUSTICK II INTRODUCER KIT M001207030","code_information":[{"code":"Px0000117521L","type":"CDM"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 145CM THG G27033","code_information":[{"code":"Px0000117985L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 6 NON FEN","code_information":[{"code":"Px0000120102L","type":"CDM"}],"standard_charges":[{"gross_charge":1393.08,"discounted_cash":1044.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRN MP 6SP 10.2F 45CM G09766","code_information":[{"code":"Px0000122632L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.99,"discounted_cash":174.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DAWSON-MUELLER 8.5FR 25CM G09705","code_information":[{"code":"Px0000122635L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG EXCH .035 260CM GR3509","code_information":[{"code":"Px0000123611L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY THORACIC 11FR 10CM TV1110","code_information":[{"code":"Px0000124606L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.05,"discounted_cash":498.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 4 NON FEN","code_information":[{"code":"Px0000125438L","type":"CDM"}],"standard_charges":[{"gross_charge":1705.67,"discounted_cash":1279.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 5 NON FEN","code_information":[{"code":"Px0000126316L","type":"CDM"}],"standard_charges":[{"gross_charge":1705.67,"discounted_cash":1279.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDECATH 4FR 65CM ANGLE TAPER CG415","code_information":[{"code":"Px0000127226L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.94,"discounted_cash":114.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ACHIEVE BIOPSY 18G X 11CM CA1811","code_information":[{"code":"Px0000127687L","type":"CDM"}],"standard_charges":[{"gross_charge":161.68,"discounted_cash":121.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE SS ANG EX .035 260 GS3509","code_information":[{"code":"Px0000127738L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.82,"discounted_cash":115.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE .035X150CM SS ANG GS3506","code_information":[{"code":"Px0000128054L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.63,"discounted_cash":112.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SUPER STIFF 75CM","code_information":[{"code":"Px0000128211L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"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":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAC-LOC 12FR 25CM CLM RH G09503","code_information":[{"code":"Px0000128499L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.51,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAINAGE 14.0P-6S CLM RH G09504","code_information":[{"code":"Px0000128500L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.51,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY THORACIC 11FR 13CM TV1113","code_information":[{"code":"Px0000128513L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.05,"discounted_cash":498.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAXIAL ACHIEVE 18X15","code_information":[{"code":"Px0000128518L","type":"CDM"}],"standard_charges":[{"gross_charge":161.68,"discounted_cash":121.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ACHIEVE BIOPSY 18G X 20CM CA1820","code_information":[{"code":"Px0000128519L","type":"CDM"}],"standard_charges":[{"gross_charge":102.89,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAXIAL ACHIEVE 20X11 CA2011","code_information":[{"code":"Px0000128520L","type":"CDM"}],"standard_charges":[{"gross_charge":102.89,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ACHIEVE BIOPSY 20G X 15CM CA2015","code_information":[{"code":"Px0000128521L","type":"CDM"}],"standard_charges":[{"gross_charge":102.89,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTAT SURGCEL NUKNIT 3X4IN 1943","code_information":[{"code":"Px0000128560L","type":"CDM"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":176.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAX ACHIEVE 14G 11CM CA1411","code_information":[{"code":"Px0000128898L","type":"CDM"}],"standard_charges":[{"gross_charge":157.37,"discounted_cash":118.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG .035 180CM GR3508","code_information":[{"code":"Px0000128901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURE HOOKWIRE 20GX7.5CM BLN20075","code_information":[{"code":"Px0000129928L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURA HOOKWIRE 5CM BLN2005","code_information":[{"code":"Px0000130296L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 21GA 7CM G03507","code_information":[{"code":"Px0000130297L","type":"CDM"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 24FR 2.5 01202425","code_information":[{"code":"Px0000132298L","type":"CDM"}],"standard_charges":[{"gross_charge":263.32,"discounted_cash":197.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 7F 11CM 401711M","code_information":[{"code":"Px0000132416L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 6FR 23CM 401623M","code_information":[{"code":"Px0000132485L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.65,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC WIRE AMPLATZ SS ST .035 180CM M001465251","code_information":[{"code":"Px0000132748L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.93,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE VASC ANG .035INX180CM GS3508","code_information":[{"code":"Px0000132914L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.35,"discounted_cash":115.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 4F 11CM 401411M","code_information":[{"code":"Px0000133229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 6FR 11CM 401611M","code_information":[{"code":"Px0000133231L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DUO LUM URET ACCESS G17323","code_information":[{"code":"Px0000133398L","type":"CDM"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 100/20 4105101","code_information":[{"code":"Px0000134022L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NEPH FLEX REG 12 X 25 M001271810","code_information":[{"code":"Px0000134619L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.29,"discounted_cash":163.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH KUMPE BT 5F 65CM G09469","code_information":[{"code":"Px0000138161L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.09,"discounted_cash":46.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 8FR 11CM 401811M","code_information":[{"code":"Px0000138229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CASE HRTMTE TRAVEL","code_information":[{"code":"Px0000138468L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":351.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 20FR 2.3","code_information":[{"code":"Px0000138545L","type":"CDM"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH FOGARTY 5.5FR 12TLW805F35","code_information":[{"code":"Px0000139737L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":182.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CATH MAHURKAR 11.5FR 16CM","code_information":[{"code":"Px0000140060L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITE TIP 7FR 23CM 401723M","code_information":[{"code":"Px0000140220L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH AVANTI 5F 11CM 504605X","code_information":[{"code":"Px0000140632L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANCHR SUT COPE GI G04474","code_information":[{"code":"Px0000141533L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":164.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT GLIDEX 8FR X 26CM M001245520","code_information":[{"code":"Px0000141651L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.7,"discounted_cash":197.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIL 10.2FR 40CM CLB RH G09498","code_information":[{"code":"Px0000142230L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"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":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC COIL HELICAL 18-6-6 M0013120331","code_information":[{"code":"Px0000142614L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.29,"discounted_cash":116.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 22FR 025022","code_information":[{"code":"Px0000143925L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":474.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIL MACLOC 14FR 40 CLB RH G09500","code_information":[{"code":"Px0000143926L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 6F 10CM RSS602","code_information":[{"code":"Px0000144473L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 7FR 10CM RSS702","code_information":[{"code":"Px0000144474L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINN 8FR 10CM RSS802","code_information":[{"code":"Px0000144475L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURA HOOKWIRE 3CM BLN2003","code_information":[{"code":"Px0000144840L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACURA HOOKWIRE 10CM BLN2010","code_information":[{"code":"Px0000144844L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 5F 10 CM RSS502","code_information":[{"code":"Px0000145003L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAIN SET TQAS POLYU 41CM 20FR G06345","code_information":[{"code":"Px0000145079L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH GORDON 22FR 40 MPA GLD HC","code_information":[{"code":"Px0000145119L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.98,"discounted_cash":159.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NEPH FLEX REG 10 X 25 M001271800","code_information":[{"code":"Px0000145418L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT GLIDEX 8FR X 22CM M001245500","code_information":[{"code":"Px0000147877L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.7,"discounted_cash":197.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 7CM G09489","code_information":[{"code":"Px0000149891L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJUNAL FEED MIC 18FR 026018","code_information":[{"code":"Px0000150440L","type":"CDM"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":659.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PARACENTESIS THORA COMBO TPT1000","code_information":[{"code":"Px0000152208L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.01,"discounted_cash":125.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP ULTRACLIP TISSUE MARKER PPU","code_information":[{"code":"Px0000154661L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 24FR .038 13CM G06446","code_information":[{"code":"Px0000155539L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 4FR 20GA 7CM G09488","code_information":[{"code":"Px0000155690L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH OMNI FLUSH 5FR 65CM H787107322035","code_information":[{"code":"Px0000155867L","type":"CDM"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PARACENTESIS","code_information":[{"code":"Px0000156015L","type":"CDM"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 145CM COO G02356","code_information":[{"code":"Px0000156078L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.38,"discounted_cash":46.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIL DRAIN 18FR 40CM G09829","code_information":[{"code":"Px0000156887L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.3,"discounted_cash":201.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 135/20 4105701","code_information":[{"code":"Px0000157257L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 135/30 4105801","code_information":[{"code":"Px0000157258L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DIL URET SET G14185","code_information":[{"code":"Px0000158419L","type":"CDM"}],"standard_charges":[{"gross_charge":706.23,"discounted_cash":529.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED MIC JEJU 18FR 0200-18 020018","code_information":[{"code":"Px0000158646L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN 6F MPL2625","code_information":[{"code":"Px0000159234L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":177.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 8FR 25CM","code_information":[{"code":"Px0000159248L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 10FR 25CM","code_information":[{"code":"Px0000159249L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 12FR 25CM","code_information":[{"code":"Px0000159250L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN SKATER 14FR 25CM","code_information":[{"code":"Px0000159251L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE AMPL SS ST EXC .035 260 M001465261","code_information":[{"code":"Px0000159521L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.73,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC AMPLATZ SS 260CM .035 3MMJ M001465021","code_information":[{"code":"Px0000159523L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.73,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 038 80CM COON","code_information":[{"code":"Px0000159640L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE COPE 018 60CM SS ST G09395","code_information":[{"code":"Px0000160276L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELWY 20FR .038 13CM G06445","code_information":[{"code":"Px0000160468L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH METAL 6 REG FEN","code_information":[{"code":"Px0000160915L","type":"CDM"}],"standard_charges":[{"gross_charge":2977.27,"discounted_cash":2232.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC IV GRSH DL 5FR 7927500","code_information":[{"code":"Px0000161749L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT - MULTI PODUS MED","code_information":[{"code":"Px0000161844L","type":"CDM"},{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT - MULTI PODUS LG","code_information":[{"code":"Px0000161845L","type":"CDM"},{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT WRIST BLK MED RT 8IN","code_information":[{"code":"Px0000162037L","type":"CDM"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":21.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJUNAL MIC 14FR 20CC BL 020014","code_information":[{"code":"Px0000200836L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJUNAL FEED 16FR 20CC BL 020016","code_information":[{"code":"Px0000200837L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE COPE 018 60CM SS G05183","code_information":[{"code":"Px0000204935L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 65/10 4104701","code_information":[{"code":"Px0000204946L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.15,"discounted_cash":168.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BERENSTEIN 4/100/035 H787107235015","code_information":[{"code":"Px0000205072L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.15,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAINAGE THAL TQAS-1800-J G06343","code_information":[{"code":"Px0000205542L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SPARTACORE 5/190 1005202","code_information":[{"code":"Px0000206332L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC WIRE SUPRA CORE 35/190CM 100270301","code_information":[{"code":"Px0000206549L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRANSGASTRIC JEJUANL 16F 025016","code_information":[{"code":"Px0000207319L","type":"CDM"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":474.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BERENSTEIN 5/65 5/BX H787107221045","code_information":[{"code":"Px0000207503L","type":"CDM"}],"standard_charges":[{"gross_charge":36.12,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 2.0 01201820","code_information":[{"code":"Px0000208620L","type":"CDM"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 3.0 01201830","code_information":[{"code":"Px0000208648L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 260CM AES G03562","code_information":[{"code":"Px0000208927L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 14FR 1.0 01201410","code_information":[{"code":"Px0000208961L","type":"CDM"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":197.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING MIC-KEY 18FR 2.5 01201825","code_information":[{"code":"Px0000209080L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPLINT THUMB AND WRIST RT LG","code_information":[{"code":"Px0000210683L","type":"CDM"},{"code":"A4570","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SENSOR .035 ST M0066703081","code_information":[{"code":"Px0000210877L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ANGIO .035 3MM H965970002021","code_information":[{"code":"Px0000211230L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":30.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NDL CENTESIS 1STEP 4FR 7C","code_information":[{"code":"Px0000211299L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH NDL CENTESIS 1STEP 5FR 7C","code_information":[{"code":"Px0000211300L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.27,"discounted_cash":43.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC VALVE SPEAKING PASSY-MUIR PMV2001","code_information":[{"code":"Px0000215999L","type":"CDM"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.65,"discounted_cash":161.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT FACET INTRO 11G 5IN","code_information":[{"code":"Px0000216652L","type":"CDM"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT FACET INTRO 13G 5IN","code_information":[{"code":"Px0000216653L","type":"CDM"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT BONE BIOPSY KIT 11G","code_information":[{"code":"Px0000216656L","type":"CDM"}],"standard_charges":[{"gross_charge":144.75,"discounted_cash":108.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL VERT BONE BIOPSY KIT 13G","code_information":[{"code":"Px0000216657L","type":"CDM"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPINCE 18X10CM 360108001","code_information":[{"code":"Px0000216900L","type":"CDM"}],"standard_charges":[{"gross_charge":151.2,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPINCE 18X15CM 360158001","code_information":[{"code":"Px0000216901L","type":"CDM"}],"standard_charges":[{"gross_charge":151.2,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTD BIOPINCE COAXIAL US MCXS1815BP","code_information":[{"code":"Px0000216904L","type":"CDM"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE SENSOR .038 ST M0066703121","code_information":[{"code":"Px0000217020L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GELMARK ULTRACOR S CLIP 14G GMUTC005SS","code_information":[{"code":"Px0000217039L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PERCARDIOCENTISIS PIGTAIL PC101","code_information":[{"code":"Px0000217584L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.2,"discounted_cash":208.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH BIVONA 8.0","code_information":[{"code":"Px0000217955L","type":"CDM"}],"standard_charges":[{"gross_charge":516.86,"discounted_cash":387.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH RCFW 12F 30CM CHECK-FLO G08956","code_information":[{"code":"Px0000218349L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELWY 22FR .038 13CM G04096","code_information":[{"code":"Px0000219489L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.07,"discounted_cash":80.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH BRITETIP 10F 11CM 401011M","code_information":[{"code":"Px0000219896L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH BIVONA 6.0 75HA60","code_information":[{"code":"Px0000220590L","type":"CDM"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PERCLOSE PROGLIDE 6FR 1267303","code_information":[{"code":"Px0000221040L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ST BENTSON .35X150","code_information":[{"code":"Px0000221296L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 145CM AUS G09954","code_information":[{"code":"Px0000222635L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER BILIARY DRAIN 8F","code_information":[{"code":"Px0000227386L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER NEPHRO DRAIN 8F","code_information":[{"code":"Px0000227387L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19G 10CM G09490","code_information":[{"code":"Px0000231047L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISS ULTRACLIP2 10CM","code_information":[{"code":"Px0000231455L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.2,"discounted_cash":111.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRACH VALVE PASSY MUIR PMV007","code_information":[{"code":"Px0000232900L","type":"CDM"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.65,"discounted_cash":161.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT SURG PREP BONE BIO W/IMP 2067100","code_information":[{"code":"Px0000236527L","type":"CDM"}],"standard_charges":[{"gross_charge":264.96,"discounted_cash":198.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 18FR .038 13CM G06444","code_information":[{"code":"Px0000238758L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TRACH PERCUT DIL 7.0MM","code_information":[{"code":"Px0000238815L","type":"CDM"}],"standard_charges":[{"gross_charge":811.79,"discounted_cash":608.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 24CM CL07624","code_information":[{"code":"Px0000239750L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.95,"discounted_cash":125.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDECATH 4FR 100CM ANGLE TAPER CG416","code_information":[{"code":"Px0000240903L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ROSEN 035 80CM 1.5MM G01774","code_information":[{"code":"Px0000241168L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 18G X 11CM","code_information":[{"code":"Px0000244328L","type":"CDM"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 18GX20CM","code_information":[{"code":"Px0000244329L","type":"CDM"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 20GX15CM ACT2015","code_information":[{"code":"Px0000244330L","type":"CDM"}],"standard_charges":[{"gross_charge":171.41,"discounted_cash":128.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 20GX20CM ACT2020","code_information":[{"code":"Px0000244331L","type":"CDM"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAC-LOC 8.5FR 25CM CLM RH G09501","code_information":[{"code":"Px0000247284L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAC-LOC 10.2FR 25 CLB HC G09502","code_information":[{"code":"Px0000247356L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.51,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH GUIDE AVE L 6FR EBU375 LA6EBU375","code_information":[{"code":"Px0000248184L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DAWSON-MUELLER 12FR 25CM G10435","code_information":[{"code":"Px0000249209L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP CORMARK 14GA MAM3014","code_information":[{"code":"Px0000249297L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 20GA 7CM G02601","code_information":[{"code":"Px0000250024L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER DRAIN 16FR 25CM 756516025","code_information":[{"code":"Px0000250301L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BIOP SYS COAXIAL ACHIEVE 20X20","code_information":[{"code":"Px0000250306L","type":"CDM"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE BENTSON .035 260CM G01063","code_information":[{"code":"Px0000251863L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 15CM G09492","code_information":[{"code":"Px0000252702L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MAHURKAR 12FR X 20CM 8888101003HP","code_information":[{"code":"Px0000252960L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER FIDUCIAL TISS SFT GOLD","code_information":[{"code":"Px0000253607L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH HEMOSTAR ST 14.5FR 23CM","code_information":[{"code":"Px0000254003L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":509.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MHRKR W/CRV TL 12FR 13CM","code_information":[{"code":"Px0000255265L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.04,"discounted_cash":198.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL HANDPIECE SUROS 12G X 12CM US","code_information":[{"code":"Px0000255503L","type":"CDM"}],"standard_charges":[{"gross_charge":502.08,"discounted_cash":376.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TRIMARK 13 TRIMARKTD13MR","code_information":[{"code":"Px0000255507L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE VASC AMPL SUPSTI 035X75 M001465631","code_information":[{"code":"Px0000255599L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE LQST STR XSTIF 260X11 G31453","code_information":[{"code":"Px0000256378L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 12F G06492","code_information":[{"code":"Px0000257213L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 14F G06496 G06496","code_information":[{"code":"Px0000257214L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN NITINOL LCK PIG 8FR NNU8LPT","code_information":[{"code":"Px0000257915L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.3,"discounted_cash":207.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 18GX15CM ACT1815","code_information":[{"code":"Px0000257920L","type":"CDM"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL COAXIAL ADJ 20GX11CM ACT2011","code_information":[{"code":"Px0000257921L","type":"CDM"}],"standard_charges":[{"gross_charge":827.78,"discounted_cash":620.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN CSV 6FR 80CM BVCS6180","code_information":[{"code":"Px0000258744L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SPHINCTEROTOME HYDRA RX44 20MM M00583040","code_information":[{"code":"Px0000259413L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.36,"discounted_cash":848.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ST BENTSON .35X80CM","code_information":[{"code":"Px0000259518L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.58,"discounted_cash":25.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN VIATRAC 7 X 40CM 100820140","code_information":[{"code":"Px0000259802L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE STORQ ANGLE .035/180 503456J","code_information":[{"code":"Px0000259857L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 6 60XLTCD","code_information":[{"code":"Px0000259993L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 6 60XLTCP","code_information":[{"code":"Px0000259994L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT UNCUFF PROX 6MM 60XLTUP","code_information":[{"code":"Px0000259995L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH 8 CUFF DIST XL 80XLTCD","code_information":[{"code":"Px0000259996L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 8 80XLTCP","code_information":[{"code":"Px0000259997L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT NOCUFF PROXIM 8 80XLTUP","code_information":[{"code":"Px0000259998L","type":"CDM"}],"standard_charges":[{"gross_charge":181.66,"discounted_cash":136.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MHRKR PRECRV TL 12FR 16CM 8888101002HP","code_information":[{"code":"Px0000260511L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":265.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 12-40MM G36229","code_information":[{"code":"Px0000260932L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.57,"discounted_cash":993.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 12-60MM G36230","code_information":[{"code":"Px0000260933L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT ZILVER 6F 14 X 30 80CM","code_information":[{"code":"Px0000260934L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 14-40MM G36234","code_information":[{"code":"Px0000260935L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.57,"discounted_cash":993.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BIL ZLVR 6F 80CM 14-60MM G36235","code_information":[{"code":"Px0000260936L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SIZING OMNI FLUSH 4FR 70C H787137090055","code_information":[{"code":"Px0000261447L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.7,"discounted_cash":61.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GDW .035-.038 X 150 ANGLED XR GR3506","code_information":[{"code":"Px0000261742L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.35,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR DL 5FR 3275108","code_information":[{"code":"Px0000262370L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 7 70XLTCP","code_information":[{"code":"Px0000262983L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 20GA 9CM G02587","code_information":[{"code":"Px0000264635L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DRNGE PLEURX 1000ML 507510","code_information":[{"code":"Px0000264749L","type":"CDM"}],"standard_charges":[{"gross_charge":202.17,"discounted_cash":151.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TLS TL 6FR FULL","code_information":[{"code":"Px0000266036L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HANDPIECE MR 20MM 3.7MM X 14CM ATEC091420MR","code_information":[{"code":"Px0000266039L","type":"CDM"}],"standard_charges":[{"gross_charge":695.95,"discounted_cash":521.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HANDPIECE MR 12MM 3.7MM X 14CM ATEC091412MR","code_information":[{"code":"Px0000266040L","type":"CDM"}],"standard_charges":[{"gross_charge":695.95,"discounted_cash":521.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER LOC SET HNDPC 20MR ILS091420","code_information":[{"code":"Px0000266041L","type":"CDM"}],"standard_charges":[{"gross_charge":383.95,"discounted_cash":287.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER LOCAL SET 12MR ILS091412","code_information":[{"code":"Px0000266042L","type":"CDM"}],"standard_charges":[{"gross_charge":383.95,"discounted_cash":287.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TLS DL 5FR FULL","code_information":[{"code":"Px0000266150L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANGIOSEAL VIP 6F 610130","code_information":[{"code":"Px0000292099L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PEELAWAY 16FR .038 G02997","code_information":[{"code":"Px0000292416L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.98,"discounted_cash":83.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 80CM 9-40MM G43861","code_information":[{"code":"Px0000292689L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 80CM 10-60M G43867","code_information":[{"code":"Px0000292693L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1818.24,"discounted_cash":1363.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MICROPUNCT 5FR NITNL/PLAT SST G43870","code_information":[{"code":"Px0000293604L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.81,"discounted_cash":56.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 5","code_information":[{"code":"Px0000293628L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 7 70XLTCD","code_information":[{"code":"Px0000293629L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT CUFF PROXIMAL 5","code_information":[{"code":"Px0000293630L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 80CM AUS","code_information":[{"code":"Px0000293980L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL SET EZ-IO AD 40-UP KG 9001VC005","code_information":[{"code":"Px0000295140L","type":"CDM"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANGIOSEAL VIP 8F 610131","code_information":[{"code":"Px0000295175L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":416.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 5FR 19GA 20CM G09491","code_information":[{"code":"Px0000297528L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL 5CM LOCALIZATION WIRE 47520","code_information":[{"code":"Px0000298220L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOCALIZATION WIRE 7CM 47720","code_information":[{"code":"Px0000298221L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP BONE MURPHY 11GAX15CM","code_information":[{"code":"Px0000299046L","type":"CDM"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH EP CLOSUREFAST 7F 60CM CF7760","code_information":[{"code":"Px0000299170L","type":"CDM"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":2919.0,"discounted_cash":2189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CLOSURE FAST 7F 100CM CF77100","code_information":[{"code":"Px0000299175L","type":"CDM"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":2919.0,"discounted_cash":2189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 US 863017","code_information":[{"code":"Px0000299264L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.99,"discounted_cash":168.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH CHECK-FLO 12FR 038 13CM G07601","code_information":[{"code":"Px0000300013L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC GRSH DL 5FR 55CM TY","code_information":[{"code":"Px0000300044L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.68,"discounted_cash":369.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC GRSH DL 5FR 45 TY","code_information":[{"code":"Px0000300045L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.32,"discounted_cash":387.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOPSY TRIMARKTD2S13MR","code_information":[{"code":"Px0000302488L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.3,"discounted_cash":67.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC TLS GRSH SL 4FR TY 9617408","code_information":[{"code":"Px0000303298L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.82,"discounted_cash":381.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER SHEATH SET 7FR 7CM","code_information":[{"code":"Px0000304142L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ACCUDRAIN W/O ANTI REFLUX VAL INS8400","code_information":[{"code":"Px0000306897L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.4,"discounted_cash":395.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP MRI ULTRACOR 14GSS","code_information":[{"code":"Px0000307078L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER PUNCTURE MICRO STIF G48008","code_information":[{"code":"Px0000307502L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 COIL 864017","code_information":[{"code":"Px0000307940L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ALL TERRN 10X40MMX40CM","code_information":[{"code":"Px0000308101L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.32,"discounted_cash":174.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP BONE MURPHY 11GAX10CM","code_information":[{"code":"Px0000308165L","type":"CDM"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":252.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CEREB 5FR 100CM .038 KMP G11457","code_information":[{"code":"Px0000308218L","type":"CDM"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET NEFF ACCESS CHIBA 21GA NT G08426","code_information":[{"code":"Px0000308328L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":153.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 10.2FR 24CM G48164","code_information":[{"code":"Px0000308331L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.98,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 8.5FR 26CM G48180","code_information":[{"code":"Px0000308339L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.99,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CHAIT TRAPDOR CECOSTOMY M G36392","code_information":[{"code":"Px0000308373L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MICROPUNCTURE TRANS NIT 4F","code_information":[{"code":"Px0000308428L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MICROPUNCT 5FR SS/PLAT USOUND","code_information":[{"code":"Px0000308436L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 21GA 5CM G02900","code_information":[{"code":"Px0000308443L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL KOPAN HOOK 21GA 9CM","code_information":[{"code":"Px0000308444L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOP COAX 20GA 9CM 10THROW G27018","code_information":[{"code":"Px0000308457L","type":"CDM"}],"standard_charges":[{"gross_charge":147.29,"discounted_cash":110.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT BILI ZLVR 6FR 14X40MM G36244","code_information":[{"code":"Px0000308479L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 125CM 10-60","code_information":[{"code":"Px0000308513L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":1545.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 125CM 6-40M G43821","code_information":[{"code":"Px0000308517L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 125CM 8-60M G43832","code_information":[{"code":"Px0000308528L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VASC ZLVR 6F 80CM 9-80MM","code_information":[{"code":"Px0000308551L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC SHERLOCK SOLO DL 5FR 9295108","code_information":[{"code":"Px0000308654L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.4,"discounted_cash":373.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG KIT VAC GRANUFOAM THIN","code_information":[{"code":"Px0000309578L","type":"CDM"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CORE BIOP DEVICE CELERO12","code_information":[{"code":"Px0000309593L","type":"CDM"}],"standard_charges":[{"gross_charge":430.71,"discounted_cash":323.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK","code_information":[{"code":"Px0000309595L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.48,"discounted_cash":73.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MICROPUNCTURE TRANS SS 4F","code_information":[{"code":"Px0000310057L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET INTRO TRACH BLUE RHINO G12115","code_information":[{"code":"Px0000310154L","type":"CDM"}],"standard_charges":[{"gross_charge":1094.5,"discounted_cash":820.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE TRACH XLT UNCUFF DST 6MM 60XLTUD","code_information":[{"code":"Px0000310908L","type":"CDM"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC GRANFM XLG KT M82750655","code_information":[{"code":"Px0000313538L","type":"CDM"}],"standard_charges":[{"gross_charge":273.65,"discounted_cash":205.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INTRODUCER KIT G48007","code_information":[{"code":"Px0000313768L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.44,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH RAABE 6FR .035 45CM RB","code_information":[{"code":"Px0000314102L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC FEM COMPRESSION WITH MANOMETER C11165","code_information":[{"code":"Px0000314807L","type":"CDM"}],"standard_charges":[{"gross_charge":248.76,"discounted_cash":186.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TISSUE MARKER WING ULTRACLP II 862017D","code_information":[{"code":"Px0000314848L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH MICRO PROGRT 2.8FR 110CM MCPE28111YB","code_information":[{"code":"Px0000325115L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1461.0,"discounted_cash":1095.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN GP LOC PGTL 8F 20CM","code_information":[{"code":"Px0000329276L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN GP LOC PGTL 10F 20C","code_information":[{"code":"Px0000329277L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT INTRODUCER MICKEY G-18 98433","code_information":[{"code":"Px0000330024L","type":"CDM"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC RFA INTRO PROBE KIT M001262220","code_information":[{"code":"Px0000330648L","type":"CDM"}],"standard_charges":[{"gross_charge":4518.0,"discounted_cash":3388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TLS SL 4FR FULL","code_information":[{"code":"Px0000331186L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.16,"discounted_cash":321.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ARCTIC SUN COOLING PAD UNIV 3170004","code_information":[{"code":"Px0000334293L","type":"CDM"}],"standard_charges":[{"gross_charge":1063.68,"discounted_cash":797.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PAD COOLING ARCTIC SUN SMALL 3170502","code_information":[{"code":"Px0000334294L","type":"CDM"}],"standard_charges":[{"gross_charge":3380.48,"discounted_cash":2535.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ARCTIC SUN COOLING PAD MED 3170702","code_information":[{"code":"Px0000334295L","type":"CDM"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":2085.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ARTIC SUN COOLING PAD LG 3170902","code_information":[{"code":"Px0000334296L","type":"CDM"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":2085.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE COATED PTFE .035","code_information":[{"code":"Px0000334484L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.22,"discounted_cash":24.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC GRANUFM SIL SENSA MED M82750965","code_information":[{"code":"Px0000335713L","type":"CDM"}],"standard_charges":[{"gross_charge":171.35,"discounted_cash":128.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PLATELET CONCENTRATE 51406","code_information":[{"code":"Px0000337899L","type":"CDM"}],"standard_charges":[{"gross_charge":410.2,"discounted_cash":307.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 11CM CL07611","code_information":[{"code":"Px0000338060L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.65,"discounted_cash":73.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL SET EZ-IO LD LONG 45MM 9079VC005","code_information":[{"code":"Px0000338790L","type":"CDM"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BILIARY 16F 40CM G09205","code_information":[{"code":"Px0000345388L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.3,"discounted_cash":201.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PK PROCEDURE CLOSUREFAST","code_information":[{"code":"Px0000346213L","type":"CDM"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PKG BATTERY","code_information":[{"code":"Px0000346720L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE J CURVE 25X100X180 G01602","code_information":[{"code":"Px0000346739L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP CELEROMARK","code_information":[{"code":"Px0000346746L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRACE LT WRIST COCKUP L3908","code_information":[{"code":"Px0000348988L","type":"CDM"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.42,"discounted_cash":154.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPSY EVIVA APERTURE 20MM EVIVA091320","code_information":[{"code":"Px0000349449L","type":"CDM"}],"standard_charges":[{"gross_charge":582.41,"discounted_cash":436.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOPSY SITE 1ST SMARKEVIVA13","code_information":[{"code":"Px0000349450L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPSY EVIVA APERTURE 12MM EVIVA091312","code_information":[{"code":"Px0000349451L","type":"CDM"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP SECURMARK EVIVA 2 SMARKEVIVA2S13","code_information":[{"code":"Px0000349452L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CATH YUEH 4FR 10CM G09646","code_information":[{"code":"Px0000350122L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 8.5FR 24CM G48176","code_information":[{"code":"Px0000350181L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.99,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE TFE 035 180CM 3J AES G03565","code_information":[{"code":"Px0000350347L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DILATOR VASCULAR 200120","code_information":[{"code":"Px0000350521L","type":"CDM"}],"standard_charges":[{"gross_charge":750.37,"discounted_cash":562.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CHEST TUBE CATH PLEURX SYS 507000B","code_information":[{"code":"Px0000351011L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1988.0,"discounted_cash":1491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN GP LOC PGTL 12F 20C","code_information":[{"code":"Px0000351084L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BX TRIMARK HRGLASS 130MM TRIMARKEVIVA2S13","code_information":[{"code":"Px0000351096L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT SMARTJET LIQ APP 51452","code_information":[{"code":"Px0000351310L","type":"CDM"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP HYDROMARK BIOPSY MARKER 40100215T1","code_information":[{"code":"Px0000353590L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.44,"discounted_cash":155.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT VASCULAR INSERTION 210CM 701063540","code_information":[{"code":"Px0000353953L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.34,"discounted_cash":325.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEED JEJU 12FR 0200-12LV 020012LV","code_information":[{"code":"Px0000355888L","type":"CDM"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 180CM GA3501","code_information":[{"code":"Px0000355901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.38,"discounted_cash":364.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DRAINAGE PLEURX 500ML 507500B","code_information":[{"code":"Px0000356479L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.17,"discounted_cash":151.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BASIC TIP DURAMAX 28CM","code_information":[{"code":"Px0000357200L","type":"CDM"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":583.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 260CM GA3502","code_information":[{"code":"Px0000357228L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.4,"discounted_cash":260.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRAIN 16FR LBL2-1630HB","code_information":[{"code":"Px0000357233L","type":"CDM"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT ANCHR MIC SAF-T-PEXY FSTNR 98701","code_information":[{"code":"Px0000357957L","type":"CDM"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":248.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PORT POWER VACCESS 8F","code_information":[{"code":"Px0000359223L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":428.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BIOPSY EVIVA 9G 10CMX12MM EVIVA091012T","code_information":[{"code":"Px0000359853L","type":"CDM"}],"standard_charges":[{"gross_charge":376.61,"discounted_cash":282.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOPSY 10CM SITE 2ND TRIMARKEVIVA2S10","code_information":[{"code":"Px0000359854L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PLEURX STARTER 500071","code_information":[{"code":"Px0000363736L","type":"CDM"}],"standard_charges":[{"gross_charge":965.03,"discounted_cash":723.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER HYDROMARK BRST 15GA 3 40100215T3","code_information":[{"code":"Px0000366500L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.44,"discounted_cash":155.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC POWDER ABSRB ARISTA 3GM SM0002USA","code_information":[{"code":"Px0000366562L","type":"CDM"}],"standard_charges":[{"gross_charge":446.83,"discounted_cash":335.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE HYDRO ANG SS 35/180 LWSTFA35180","code_information":[{"code":"Px0000366598L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.83,"discounted_cash":78.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN HSG SHOLKOFF","code_information":[{"code":"Px0000366600L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":128.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAINAGE SET FUHRMAN PLEURAL G55723","code_information":[{"code":"Px0000367013L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CV PRESS INJ 3L 7FR 20CM CDC45703XP1A","code_information":[{"code":"Px0000368960L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.64,"discounted_cash":256.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBING VACUUM ASSIST 1/4 X32","code_information":[{"code":"Px0000369224L","type":"CDM"}],"standard_charges":[{"gross_charge":238.44,"discounted_cash":178.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE HYDRO STD ANG 35/150","code_information":[{"code":"Px0000369332L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.28,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMADA .014 2.0X80X150 A2020080","code_information":[{"code":"Px0000369834L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BATTERY HRTMET 14V LI-ON SET","code_information":[{"code":"Px0000372405L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1417.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP BATT HRTME LI-ON 14V SET","code_information":[{"code":"Px0000372406L","type":"CDM"},{"code":"Q0497","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.14,"discounted_cash":1251.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CHARGER HRTMTE BATT UNIV","code_information":[{"code":"Px0000372411L","type":"CDM"},{"code":"Q0495","type":"HCPCS"}],"standard_charges":[{"gross_charge":19296.0,"discounted_cash":14472.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CENTESIS 5FR 7CM","code_information":[{"code":"Px0000372561L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.58,"discounted_cash":48.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEEDING JEJU 18F 3.0","code_information":[{"code":"Px0000372621L","type":"CDM"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEEDING JEJU 18F 3.5 02301835","code_information":[{"code":"Px0000372622L","type":"CDM"}],"standard_charges":[{"gross_charge":321.11,"discounted_cash":240.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRIDLE NASAL 10FR TEAL 44110","code_information":[{"code":"Px0000372974L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRIDLE NASAL 12FR DARK BLUE","code_information":[{"code":"Px0000372975L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT TUBE FEED JEJU 18FR 4.0","code_information":[{"code":"Px0000373011L","type":"CDM"}],"standard_charges":[{"gross_charge":487.49,"discounted_cash":365.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BASIC TIP DURAMAX 24CM H787103028035","code_information":[{"code":"Px0000374024L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":583.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT URO MACLOC 10.2FR 26CM G48166","code_information":[{"code":"Px0000374035L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.98,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CABLE HRTMTE PAT 14V","code_information":[{"code":"Px0000374514L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":3463.0,"discounted_cash":2597.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TCS DL 5FR FULL 1275108","code_information":[{"code":"Px0000375324L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLOOD PUMP CENTRIMAG DISP 20190015","code_information":[{"code":"Px0000375741L","type":"CDM"}],"standard_charges":[{"gross_charge":28836.0,"discounted_cash":21627.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ABD ABTHERA OPEN SENSA M82750265","code_information":[{"code":"Px0000375884L","type":"CDM"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":1011.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 10ML 9390110","code_information":[{"code":"Px0000375923L","type":"CDM"}],"standard_charges":[{"gross_charge":27.82,"discounted_cash":20.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 20ML 9390120","code_information":[{"code":"Px0000375924L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 30ML 9390130","code_information":[{"code":"Px0000375925L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +8 40ML 9390140","code_information":[{"code":"Px0000375926L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +10 50ML 9390150","code_information":[{"code":"Px0000375927L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOPSY ONCONTROL 152MM 9411VC006","code_information":[{"code":"Px0000376101L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.55,"discounted_cash":312.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH PINNACLE 4FR MARKER","code_information":[{"code":"Px0000378320L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER BILIARY DRAIN 10FR 755310040","code_information":[{"code":"Px0000378765L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYSTEM INCISION MGMT PREVENA PRE1001US","code_information":[{"code":"Px0000384110L","type":"CDM"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 5X20MMX80CM B1050020","code_information":[{"code":"Px0000385271L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 5X40MMX80CM B1050040","code_information":[{"code":"Px0000385272L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 5X60MMX80CM B1050060","code_information":[{"code":"Px0000385273L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X20MMX80CM B1060020","code_information":[{"code":"Px0000385277L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X40MMX80CM B1060040","code_information":[{"code":"Px0000385278L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X60MMX80CM","code_information":[{"code":"Px0000385279L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X20MMX80CM B1070020","code_information":[{"code":"Px0000385283L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.8,"discounted_cash":131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X40MMX80CM B1070040","code_information":[{"code":"Px0000385284L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X60MMX80CM","code_information":[{"code":"Px0000385285L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X20MMX80CM B1080020","code_information":[{"code":"Px0000385289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X40MMX80CM B1080040","code_information":[{"code":"Px0000385290L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X60MMX80CM","code_information":[{"code":"Px0000385291L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X80MMX80CM B1080080","code_information":[{"code":"Px0000385292L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 9X20MMX80CM B1090020","code_information":[{"code":"Px0000385293L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 9X40MMX80CM B1090040","code_information":[{"code":"Px0000385294L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 10X20MMX80CM B1100020","code_information":[{"code":"Px0000385297L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 10X40MMX80CM B1100040","code_information":[{"code":"Px0000385298L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 12X40MMX80CM B1120040","code_information":[{"code":"Px0000385302L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 6X20MMX135CM B2060020","code_information":[{"code":"Px0000385323L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 7X40MMX135CM B2070040","code_information":[{"code":"Px0000385330L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 8X40MMX135CM B2080040","code_information":[{"code":"Px0000385336L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 10X40MMX135CM B2100040","code_information":[{"code":"Px0000385344L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN ARMDA .035 14X40MMX135CM B2140040","code_information":[{"code":"Px0000385352L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TL 5FR HF TY 3385108Q","code_information":[{"code":"Px0000386113L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR TCS TL 5FR HF TY","code_information":[{"code":"Px0000386721L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":492.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HANDPIECE EVIVA 9G X 13CM 12MM EVIVA091312T","code_information":[{"code":"Px0000387036L","type":"CDM"}],"standard_charges":[{"gross_charge":582.41,"discounted_cash":436.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER BILIARY DRAIN 12FR 755312040","code_information":[{"code":"Px0000387497L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH SKATER NEPHRO DRAIN 10F 755610035","code_information":[{"code":"Px0000387498L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.56,"discounted_cash":202.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH FOLEY SILICONE 30FR X 30CC","code_information":[{"code":"Px0000387503L","type":"CDM"},{"code":"A4344","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRAIN CHEST EXPR SGL 4000100N","code_information":[{"code":"Px0000388429L","type":"CDM"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYS BOWEL MGMT DIGNICARE ADV SMS002","code_information":[{"code":"Px0000388838L","type":"CDM"}],"standard_charges":[{"gross_charge":319.37,"discounted_cash":239.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK FOR ATEC 36-12","code_information":[{"code":"Px0000390361L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK FOR CELERO 2S","code_information":[{"code":"Px0000390362L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP SECURMARK FOR ATEC MRI SS2","code_information":[{"code":"Px0000390363L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN BAKRI POSTPARTUM RAPID G24237 CDM","code_information":[{"code":"Px0000392702L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR 3CG SL 4FR MAX 1194108D","code_information":[{"code":"Px0000393400L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":471.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR 3CG DL 5FR MAX 1295108D","code_information":[{"code":"Px0000393401L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC VERAFLO MED ULTVFL05MD","code_information":[{"code":"Px0000397886L","type":"CDM"},{"code":"A6550","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.03,"discounted_cash":237.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CASSETTE VAC VERALINK ULTLNK0500","code_information":[{"code":"Px0000397888L","type":"CDM"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX14CM WR-35CM 47020","code_information":[{"code":"Px0000402273L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.04,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX3CM WR-15CM 47320","code_information":[{"code":"Px0000402275L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX9CM WR-20CM 47920","code_information":[{"code":"Px0000402276L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT PASV 4FR XCELA PICC 55CM","code_information":[{"code":"Px0000410965L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.19,"discounted_cash":621.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BOOT HEEL ROOKE FLOAT","code_information":[{"code":"Px0000416701L","type":"CDM"}],"standard_charges":[{"gross_charge":282.75,"discounted_cash":212.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BX SECURMARK EVIVA INFINITY SMARKE13SS2","code_information":[{"code":"Px0000421809L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 9F 13CM SS9","code_information":[{"code":"Px0000424288L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.46,"discounted_cash":67.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CTRLR BACK UP PKT HRTMTE II","code_information":[{"code":"Px0000432200L","type":"CDM"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":1053.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BAG PC CONSOL HRTMTE II LT","code_information":[{"code":"Px0000432201L","type":"CDM"},{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BAG PC CONSOL HRTMTE II RT","code_information":[{"code":"Px0000432202L","type":"CDM"},{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.82,"discounted_cash":742.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HOLTER VEST, SMALL POCKET CONTROLLER","code_information":[{"code":"Px0000432203L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.67,"discounted_cash":268.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HOLTER VEST, MEDIUM POCKET CONTROLLER","code_information":[{"code":"Px0000432204L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":306.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HOLTER VEST, LARGE POCKET CONTROLLER","code_information":[{"code":"Px0000432205L","type":"CDM"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"discounted_cash":835.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHOWER BAG POCKET CONTROLLER","code_information":[{"code":"Px0000432207L","type":"CDM"},{"code":"Q0501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":951.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC WEARABLE ACCESS KIT","code_information":[{"code":"Px0000432208L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BATTERY RECHG HM II","code_information":[{"code":"Px0000433907L","type":"CDM"},{"code":"Q0495","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE LARY PRVX 9/55","code_information":[{"code":"Px0000434309L","type":"CDM"}],"standard_charges":[{"gross_charge":480.81,"discounted_cash":360.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE LARY PRVX 10/55","code_information":[{"code":"Px0000434310L","type":"CDM"}],"standard_charges":[{"gross_charge":480.81,"discounted_cash":360.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GWIRE PICC SS .018X80CM","code_information":[{"code":"Px0000437520L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE HYDRO STR SS 35/180 LWSTDS35180","code_information":[{"code":"Px0000439748L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":70.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN CODA 9FR 32MMX120CM G03831","code_information":[{"code":"Px0000441101L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.0,"discounted_cash":936.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PACK PROC TENOTMY TX1 5541003001","code_information":[{"code":"Px0000447803L","type":"CDM"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":1032.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STNT BILI SUPERA 4.5MMX80MMX120CM 6FR S45080120P6","code_information":[{"code":"Px0000449402L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3445.0,"discounted_cash":2583.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CVC POWER KIT 8.5 FR CDC42854XP1A","code_information":[{"code":"Px0000449434L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STNT BILI SUPERA 5.5MMX40MMX120CM 6FR S55040120P6","code_information":[{"code":"Px0000449683L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":2502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CVC DL 7 FR 20 CM","code_information":[{"code":"Px0000454589L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":238.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET HLS ADVANCED 701052794","code_information":[{"code":"Px0000456393L","type":"CDM"}],"standard_charges":[{"gross_charge":30705.0,"discounted_cash":23028.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX DISC 14MM GS5140","code_information":[{"code":"Px0000457174L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.55,"discounted_cash":375.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 2X3CM GS5230","code_information":[{"code":"Px0000457175L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":448.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 7X5X120CM VBHR070502A","code_information":[{"code":"Px0000458372L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7582.0,"discounted_cash":5686.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 7X10X120CM VBHR071002A","code_information":[{"code":"Px0000458374L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7812.0,"discounted_cash":5859.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 7X15X120CM VBHR071502A","code_information":[{"code":"Px0000458376L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9884.0,"discounted_cash":7413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VIABAHN A HEP 8X5X120CM VBHR080502A","code_information":[{"code":"Px0000458381L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7582.0,"discounted_cash":5686.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED TG M-KEY 22FX3.5X45 0270223545","code_information":[{"code":"Px0000458956L","type":"CDM"}],"standard_charges":[{"gross_charge":932.77,"discounted_cash":699.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .018X180CM","code_information":[{"code":"Px0000462937L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":428.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .014X180CM EA 1 EA","code_information":[{"code":"Px0000462939L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GLIDEWIRE ANG ADV .014X300CM GA1430","code_information":[{"code":"Px0000462940L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACTA CREAM 10ML CALORIC FORTIFIER","code_information":[{"code":"Px0000463588L","type":"CDM"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":13.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 18G 10CM 1810MSK","code_information":[{"code":"Px0000463600L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 18G 16CM 1816MSK","code_information":[{"code":"Px0000463601L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 18G 20CM 1820MSK","code_information":[{"code":"Px0000463602L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 20G 20CM 2020MSK","code_information":[{"code":"Px0000463603L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 20G 16CM 2016MSK","code_information":[{"code":"Px0000463604L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOP CORE MISSION 20G 10CM 2010MSK","code_information":[{"code":"Px0000463605L","type":"CDM"}],"standard_charges":[{"gross_charge":120.31,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CRYOABLATION ICEROD 1.5 CX FPRPR3533","code_information":[{"code":"Px0000465530L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE BRST VI 14G SMUC10V","code_information":[{"code":"Px0000511176L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISSUE BRST PNK 14G","code_information":[{"code":"Px0000511177L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CV PRES MNTR SL 2.5F 15CM G02838","code_information":[{"code":"Px0000514243L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.85,"discounted_cash":92.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PACK CUST ECMO CP PRIM","code_information":[{"code":"Px0000516095L","type":"CDM"}],"standard_charges":[{"gross_charge":693.35,"discounted_cash":520.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED J MIC-KEY LP 14F 3.5","code_information":[{"code":"Px0000536362L","type":"CDM"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOP COAX ONCTRL 15X19CM","code_information":[{"code":"Px0000536441L","type":"CDM"}],"standard_charges":[{"gross_charge":1318.35,"discounted_cash":988.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOP COAX ONCTRL 10X14CM 9464VC006","code_information":[{"code":"Px0000536442L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.35,"discounted_cash":988.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 18MM DISK GS5180","code_information":[{"code":"Px0000546501L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.4,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 2X2CM GS5220","code_information":[{"code":"Px0000546502L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.31,"discounted_cash":480.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT TISS EPIFIX 2X4CM GS5240","code_information":[{"code":"Px0000546503L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT AMNIOTIC EPIFIX 3.5X3.5CM ES3300","code_information":[{"code":"Px0000546506L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":229.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MESH EPFIX 4X 4.5 CM ES4400","code_information":[{"code":"Px0000546507L","type":"CDM"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.13,"discounted_cash":38.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PNEUMOTHORAX TRAY 14FR 29CMN G56537","code_information":[{"code":"Px0000547367L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.07,"discounted_cash":486.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN OTW ARMDA .18 4.0X40X90CM EA 1 EA","code_information":[{"code":"Px0000590690L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN OTW ARMDA .18 5.0X40X90CM EA 1 EA","code_information":[{"code":"Px0000590699L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET BOWL CELL SAVER 225","code_information":[{"code":"Px0000591212L","type":"CDM"}],"standard_charges":[{"gross_charge":312.72,"discounted_cash":234.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 17F X 15CM 701053087","code_information":[{"code":"Px0000593999L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 19F","code_information":[{"code":"Px0000594000L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 21F X 15CM 701053089","code_information":[{"code":"Px0000594001L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VL 23F 701053092","code_information":[{"code":"Px0000594003L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL W/ 0.28X20MM GOLD ANCHOR MRKR 0.5X150M","code_information":[{"code":"Px0000594212L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST 14GA 10CM SMUC10H","code_information":[{"code":"Px0000596103L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR SE 12FR 20CM 8888221420","code_information":[{"code":"Px0000596634L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR CE 12FR 20CM","code_information":[{"code":"Px0000596635L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR CE 12FR 16CM","code_information":[{"code":"Px0000596638L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH MHRKR SE 12FR 24CM","code_information":[{"code":"Px0000596639L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT ZILVER S PTX 8X60MM G38516","code_information":[{"code":"Px0000604364L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":3105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST BIOPSY CORE NDL 12GX10CM MQK1210","code_information":[{"code":"Px0000607519L","type":"CDM"}],"standard_charges":[{"gross_charge":253.66,"discounted_cash":190.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY IC MHRKR CRV DL 12FRX20CM","code_information":[{"code":"Px0000607671L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.08,"discounted_cash":233.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BIOFL DURAMAX 15.5FR 24CM H965103028031","code_information":[{"code":"Px0000607693L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.45,"discounted_cash":432.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP APPLR SURGICLIP SM-9.0 133650","code_information":[{"code":"Px0000607779L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.92,"discounted_cash":35.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEVICE CRE SERTERA SPR LD 12G SERTERA12","code_information":[{"code":"Px0000608261L","type":"CDM"}],"standard_charges":[{"gross_charge":184.6,"discounted_cash":138.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEVICE CRE SERTERA SPR LD 14G SERTERA14","code_information":[{"code":"Px0000608262L","type":"CDM"}],"standard_charges":[{"gross_charge":184.59,"discounted_cash":138.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY THRACNTSIS SFTY PLS C","code_information":[{"code":"Px0000608892L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.64,"discounted_cash":58.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BIOSENTRY SEALANT SYS 768022019S","code_information":[{"code":"Px0000610418L","type":"CDM"},{"code":"C2613","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":740.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ELCTRD RESUS 1 STEP ADLT 8EA 8900021401","code_information":[{"code":"Px0000610652L","type":"CDM"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH BLN CODA 10FR 140CM G23773","code_information":[{"code":"Px0000610709L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.0,"discounted_cash":936.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME 1.5X2CM PS11015 3SQCM","code_information":[{"code":"Px0000610775L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":554.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX PRIME 2X3 CM EA PS11023 6SQCM","code_information":[{"code":"Px0000610776L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX PRIME 3X4 CM EA PS11034 12SQCM","code_information":[{"code":"Px0000610777L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX PRIME 5X5 CM EA PS11055 25SQCM","code_information":[{"code":"Px0000610778L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX CRE 1.5X2CM PS12015 3SQCM","code_information":[{"code":"Px0000610781L","type":"CDM"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":554.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG ALGRFT GRAFIX CRE 2X3CM PS12023","code_information":[{"code":"Px0000610782L","type":"CDM"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.68,"discounted_cash":347.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET BIOPSY LIVER ACCESS G50779","code_information":[{"code":"Px0000612523L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.0,"discounted_cash":884.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT WND PREVENA PEEL/PLC 13CM PRE1101US","code_information":[{"code":"Px0000613314L","type":"CDM"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACT RTF 26 100ML 95026100","code_information":[{"code":"Px0000616189L","type":"CDM"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACT RTF 28 100ML 95028100","code_information":[{"code":"Px0000616190L","type":"CDM"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISS BRST ULTCOR 17G UCTW17","code_information":[{"code":"Px0000622671L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.54,"discounted_cash":176.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH CV POWER POLY MDL SL 4FR P4154108D","code_information":[{"code":"Px0000623259L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYS INCIS MGMT PREVENA PLUS PRE4001US","code_information":[{"code":"Px0000624882L","type":"CDM"},{"code":"A6550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":1205.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST CORE BIOP MARQUEE DSP 16G","code_information":[{"code":"Px0000625021L","type":"CDM"}],"standard_charges":[{"gross_charge":161.15,"discounted_cash":120.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BRACE KNEE ADV CIR LSS 26I","code_information":[{"code":"Px0000637119L","type":"CDM"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":232.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SHEATH VASC FLXSHTH 12F 33CM DSF1233","code_information":[{"code":"Px0000637127L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH ICY INTVASC HME IC-38","code_information":[{"code":"Px0000638029L","type":"CDM"}],"standard_charges":[{"gross_charge":2291.0,"discounted_cash":1718.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MARQUEE W/COAX 14GAX10CM","code_information":[{"code":"Px0000638781L","type":"CDM"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC LIGASURE IMPACT 36MM-18CM LF4418","code_information":[{"code":"Px0000638812L","type":"CDM"}],"standard_charges":[{"gross_charge":1601.7,"discounted_cash":1201.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT HUM TISS EPICORD 2X3 CM EC5230 6SQCM","code_information":[{"code":"Px0000640227L","type":"CDM"},{"code":"Q4187","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.7,"discounted_cash":445.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT TISS EPICORD 3X5CM EC5350 15SQCM","code_information":[{"code":"Px0000640228L","type":"CDM"},{"code":"Q4187","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.66,"discounted_cash":435.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN SPCMKR PRO SBT OVAL LF LAP 5MM SMBTTOVLX","code_information":[{"code":"Px0000643196L","type":"CDM"}],"standard_charges":[{"gross_charge":788.06,"discounted_cash":591.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MOBILE POWER UNIT HEARTMATE","code_information":[{"code":"Px0000644031L","type":"CDM"},{"code":"Q0479","type":"HCPCS"}],"standard_charges":[{"gross_charge":21360.0,"discounted_cash":16020.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY BIOP ARW ONCTRL 6X10CM","code_information":[{"code":"Px0000659084L","type":"CDM"}],"standard_charges":[{"gross_charge":1307.0,"discounted_cash":980.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NEUROPROTECTION SYS ENROUTE SR200NPS","code_information":[{"code":"Px0000659578L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":8808.0,"discounted_cash":6606.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT SYS ENROUTE TRNSCAR 10X40 SR1040CS","code_information":[{"code":"Px0000659596L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6689.0,"discounted_cash":5016.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MICRO INTRODUCER KIT 21G SR4F21G7DMP","code_information":[{"code":"Px0000659598L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE ENROUTE 0.014 SR014GW","code_information":[{"code":"Px0000659599L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":318.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJU G-JET 16F X 2.0CM X 22CM","code_information":[{"code":"Px0000659848L","type":"CDM"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":925.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE JEJU G-JET 16FR 3.5X45CM","code_information":[{"code":"Px0000659858L","type":"CDM"}],"standard_charges":[{"gross_charge":1421.86,"discounted_cash":1066.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC THERAPY UNIT PREVENA PLS 125","code_information":[{"code":"Px0000659986L","type":"CDM"}],"standard_charges":[{"gross_charge":298.17,"discounted_cash":223.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DRSG VAC VFLO CLEANSE CHCE MED ULTVCC05MDS","code_information":[{"code":"Px0000659988L","type":"CDM"}],"standard_charges":[{"gross_charge":375.16,"discounted_cash":281.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK PROF Q SHP 12CM 351222","code_information":[{"code":"Px0000660351L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.36,"discounted_cash":131.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK VISION 10CM","code_information":[{"code":"Px0000660352L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.81,"discounted_cash":175.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BREVERA 9GA 13CM","code_information":[{"code":"Px0000660356L","type":"CDM"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":467.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT LIFESTREAM 6 X 16 X 80 LSMU0800616","code_information":[{"code":"Px0000661029L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5775.0,"discounted_cash":4331.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT LIFESTREAM 8X26X80 EA LSMU0800826","code_information":[{"code":"Px0000661038L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5754.0,"discounted_cash":4315.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT LIFESTREAM 10X58X80 LSMU0801058","code_information":[{"code":"Px0000661044L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5754.0,"discounted_cash":4315.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PACK PROC TX 2","code_information":[{"code":"Px0000661074L","type":"CDM"}],"standard_charges":[{"gross_charge":2142.0,"discounted_cash":1606.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRNG UNIV 12FR EA 1 EA","code_information":[{"code":"Px0000663541L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DRNGE MULT 18FR 25CM G07774","code_information":[{"code":"Px0000663689L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.3,"discounted_cash":201.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK PROF X SHP 10CM","code_information":[{"code":"Px0000663883L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.36,"discounted_cash":131.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK PROF Q SHP 10CM 351220","code_information":[{"code":"Px0000663884L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.36,"discounted_cash":131.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 5CM SSR0501","code_information":[{"code":"Px0000664459L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 7.5CM SSR7501","code_information":[{"code":"Px0000664460L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 10CM SSR1001","code_information":[{"code":"Px0000664461L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANTENNA MWA PERC EMPRINT 15CM CA15L2","code_information":[{"code":"Px0000664532L","type":"CDM"}],"standard_charges":[{"gross_charge":8226.0,"discounted_cash":6169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ANTENNA MWA PERC EMPRINT 20CM CA20L2","code_information":[{"code":"Px0000664533L","type":"CDM"}],"standard_charges":[{"gross_charge":8226.0,"discounted_cash":6169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SYSTEM NSL TB BRDLE PRO 8-","code_information":[{"code":"Px0000665568L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHIATAS BEAD 20GAX9CM 479201","code_information":[{"code":"Px0000665604L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.4,"discounted_cash":110.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VL 25F 701053093","code_information":[{"code":"Px0000667915L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VL 29F 701053094","code_information":[{"code":"Px0000667916L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CRT-D MOMENTUM IS 1 DF1 PM18","code_information":[{"code":"Px0000668173L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":23752.32,"discounted_cash":17814.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CTRLR PCKT LVAD HEARTMATE 3","code_information":[{"code":"Px0000668661L","type":"CDM"},{"code":"Q0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":14740.0,"discounted_cash":11055.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CABLE MOD LVAD HEARTMATE 3","code_information":[{"code":"Px0000668742L","type":"CDM"},{"code":"Q0508","type":"HCPCS"}],"standard_charges":[{"gross_charge":12783.0,"discounted_cash":9587.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS PREC PR15","code_information":[{"code":"Px0000669365L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS MAX LK15XT","code_information":[{"code":"Px0000669367L","type":"CDM"}],"standard_charges":[{"gross_charge":5247.0,"discounted_cash":3935.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS MAX LK20XT","code_information":[{"code":"Px0000669368L","type":"CDM"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS PREC PR15XT","code_information":[{"code":"Px0000669369L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS PREC PR20XT","code_information":[{"code":"Px0000669370L","type":"CDM"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE MWA CERTUS SR25","code_information":[{"code":"Px0000669371L","type":"CDM"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED IRIS 10FR 43IN 461043E","code_information":[{"code":"Px0000670713L","type":"CDM"}],"standard_charges":[{"gross_charge":570.47,"discounted_cash":427.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED IRIS 12 FR 43IN 461243E","code_information":[{"code":"Px0000670717L","type":"CDM"}],"standard_charges":[{"gross_charge":570.47,"discounted_cash":427.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CLIP NSL TB FEED BRDLE 18FR 44218","code_information":[{"code":"Px0000678103L","type":"CDM"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":186.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN CONQUESTT 9MM 4CM 75CM LX3575660V","code_information":[{"code":"Px0000678659L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3463.0,"discounted_cash":2597.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KT CATH IV ANTIMIC 5ML 10CM20G","code_information":[{"code":"Px0000679403L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.08,"discounted_cash":239.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC LUMEN 5FR S1395108D4","code_information":[{"code":"Px0000679421L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.57,"discounted_cash":637.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC SL 4FR 1194108D4","code_information":[{"code":"Px0000679422L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.99,"discounted_cash":523.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC DL SOLO 5FR","code_information":[{"code":"Px0000679423L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.98,"discounted_cash":354.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SCOPE ASCOPE4 SLIM 3.8/1.2","code_information":[{"code":"Px0000680338L","type":"CDM"}],"standard_charges":[{"gross_charge":693.35,"discounted_cash":520.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH IV REINF PWRGLD 10CMX18GA F118107T","code_information":[{"code":"Px0000680427L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.06,"discounted_cash":149.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PICC SOLO SL W/GUARDIVA 4FR","code_information":[{"code":"Px0000681230L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.86,"discounted_cash":540.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 16MM 2SQCM PS13016","code_information":[{"code":"Px0000682559L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.16,"discounted_cash":471.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 1.5X2CM 3SQCM","code_information":[{"code":"Px0000682560L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.2,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT GRAFIX PRIME PLS 3X3CM PS13033 9SQCM","code_information":[{"code":"Px0000682562L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.5,"discounted_cash":260.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC IMP REFLCT W/DEL NDL 7.5CM SGL SSR75S01","code_information":[{"code":"Px0000688187L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-PVS 25F X 38CM 701053098","code_information":[{"code":"Px0000702257L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-PVS 23F X 38CM 701053097","code_information":[{"code":"Px0000702258L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT 2DRSG PICO7 NPWT 10X20CM 66022002","code_information":[{"code":"Px0000702383L","type":"CDM"}],"standard_charges":[{"gross_charge":752.78,"discounted_cash":564.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DRSG PICO7 NPWT 10X40CM 66022014","code_information":[{"code":"Px0000702395L","type":"CDM"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC BLN DC LUTONIX PTA 4X40X130 LX181304404F","code_information":[{"code":"Px0000710641L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":2502.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC COIL EMBOLIZATION MICRO NESTER G47337 0.018INX2MMX7CM","code_information":[{"code":"Px0000710800L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.39,"discounted_cash":188.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER MAGSEED 18GA 7CM","code_information":[{"code":"Px0000711359L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.32,"discounted_cash":1103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER MAGSEED 18GA 12CM","code_information":[{"code":"Px0000711360L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.32,"discounted_cash":1103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET ASPIR SIMPLE PNEUMOTHOR G05297","code_information":[{"code":"Px0000716939L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.2,"discounted_cash":191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST CORE BIOP MSN 18GX6CM 1806MS","code_information":[{"code":"Px0000717314L","type":"CDM"}],"standard_charges":[{"gross_charge":109.08,"discounted_cash":81.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MR NDL LOC GHAT 20GAX5CM 475201","code_information":[{"code":"Px0000717343L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.61,"discounted_cash":75.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL LOC GHAT 20GAX7CM 477201","code_information":[{"code":"Px0000717344L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.4,"discounted_cash":110.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC INST CORE BIOP MARQ 18GX10CM","code_information":[{"code":"Px0000717472L","type":"CDM"},{"code":"A4215","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.2,"discounted_cash":117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER TISS SENOMARK COIL 12G","code_information":[{"code":"Px0000717490L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.51,"discounted_cash":171.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TISSUE MARKER RIBBON","code_information":[{"code":"Px0000717505L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST TISS COIL 14GX13CM","code_information":[{"code":"Px0000717506L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST TISS RIB 14GX13CM","code_information":[{"code":"Px0000717508L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BRST TISS VENUS14G X13CM","code_information":[{"code":"Px0000717509L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.48,"discounted_cash":166.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 15ML 9390115","code_information":[{"code":"Px0000717862L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AL 15FR X 23CM 701053081","code_information":[{"code":"Px0000722657L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AL 19FR X 23CM 701053083","code_information":[{"code":"Px0000722659L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AL 21FR 701053084","code_information":[{"code":"Px0000722660L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS AS 23FR X 15CM 701053090","code_information":[{"code":"Px0000722662L","type":"CDM"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANNULA BEQ-HLS VS 21FR X 38CM 701053096","code_information":[{"code":"Px0000722663L","type":"CDM"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC APPLIC HMOST FLOSEAL FAST 5ML ADS201844","code_information":[{"code":"Px0000723899L","type":"CDM"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC APPLIC HMOST FLOSEAL FAST 10ML ADS201845","code_information":[{"code":"Px0000723900L","type":"CDM"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":488.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC OXGNTR BIOLINE QUADROX-ID 701067859","code_information":[{"code":"Px0000724369L","type":"CDM"}],"standard_charges":[{"gross_charge":2653.73,"discounted_cash":1990.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEVICE RHINOLARYNGOSCOPE FLEXIBLE COMPACT 510001000","code_information":[{"code":"Px0000725375L","type":"CDM"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 20CM","code_information":[{"code":"Px0000761726L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 22CM","code_information":[{"code":"Px0000761727L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 24CM","code_information":[{"code":"Px0000761728L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT NEPHURET 8FR 26CM","code_information":[{"code":"Px0000761729L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":4111.0,"discounted_cash":3083.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROBE ELEV BRST BIOPSY SYS EV12","code_information":[{"code":"Px0000761774L","type":"CDM"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY CATH PICC MAX DL 4 FR S1294108D4","code_information":[{"code":"Px0000762776L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.35,"discounted_cash":598.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT XLUNG","code_information":[{"code":"Px0000766419L","type":"CDM"}],"standard_charges":[{"gross_charge":21783.0,"discounted_cash":16337.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THIN 19X22CM 418SQCM PP1500","code_information":[{"code":"Px0000772292L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.48,"discounted_cash":60.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THIN 21X24CM 504SQCM PP0002","code_information":[{"code":"Px0000772293L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.31,"discounted_cash":54.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THCK 17.5X20 350SQCM PP2001","code_information":[{"code":"Px0000772295L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.27,"discounted_cash":62.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THCK 19X22CM 418SQCM PP1502","code_information":[{"code":"Px0000772296L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.48,"discounted_cash":60.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT DERM PRE-THCK 21X24CM 504SQCM PP2002","code_information":[{"code":"Px0000772297L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.31,"discounted_cash":54.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEEDING NASAL 12-14FR 4-421214","code_information":[{"code":"Px0000774605L","type":"CDM"}],"standard_charges":[{"gross_charge":249.05,"discounted_cash":186.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT MIC-KY ENFIT 14FR 1.5C 8140141.5","code_information":[{"code":"Px0000774907L","type":"CDM"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":197.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT MIC-KY ENFIT 18FR 2.0C 8140182","code_information":[{"code":"Px0000774932L","type":"CDM"}],"standard_charges":[{"gross_charge":263.32,"discounted_cash":197.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT MIC-KEY ENFIT 24FR 4.0C 814024400","code_information":[{"code":"Px0000774955L","type":"CDM"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT MIC SFTY PEG 20FR 818020","code_information":[{"code":"Px0000774962L","type":"CDM"}],"standard_charges":[{"gross_charge":263.47,"discounted_cash":197.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUBE FEED JEJU 18FR 45CM","code_information":[{"code":"Px0000774991L","type":"CDM"}],"standard_charges":[{"gross_charge":589.83,"discounted_cash":442.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT JEJU 16FR 2.5CM","code_information":[{"code":"Px0000775015L","type":"CDM"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET EXT JEJU 22FR 3.0CM","code_information":[{"code":"Px0000775038L","type":"CDM"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":699.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT VBAHN HEP 10MMX10CM 8F VBHR101002A","code_information":[{"code":"Px0000776668L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8859.0,"discounted_cash":6644.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL BREVERA 9G 20MM 13CM BREVDISP09","code_information":[{"code":"Px0000776934L","type":"CDM"}],"standard_charges":[{"gross_charge":653.73,"discounted_cash":490.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER 20 10CM 090007","code_information":[{"code":"Px0000776937L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.42,"discounted_cash":581.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER 7 10CM 090028","code_information":[{"code":"Px0000776938L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.42,"discounted_cash":581.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER 20 090029","code_information":[{"code":"Px0000776939L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.42,"discounted_cash":581.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET APPLIC LOCALIZER-S 20 10CM","code_information":[{"code":"Px0000777003L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.42,"discounted_cash":376.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOFILTER CRRT TREAT OXIRIS 955503","code_information":[{"code":"Px0000780757L","type":"CDM"}],"standard_charges":[{"gross_charge":812.72,"discounted_cash":609.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROSTHESIS URO RECTAL SPACER KIT SPACEOAR VUE SYNTHETIC 10ML SV2101","code_information":[{"code":"Px0000781428L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9720.0,"discounted_cash":7290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH PICC PWR PROVENA TL 5FR S9385108D","code_information":[{"code":"Px0000781616L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.78,"discounted_cash":441.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT CATH 10CM 18GA STRL LF DIS F318108PT","code_information":[{"code":"Px0000800457L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.8,"discounted_cash":248.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CANN VEN 27FR WITHINTROUDUCER 96670127","code_information":[{"code":"Px0000804321L","type":"CDM"}],"standard_charges":[{"gross_charge":1005.05,"discounted_cash":753.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CRYOABLAT FORCE 2.1 CX 90D FPRPR3602","code_information":[{"code":"Px0000805635L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC  NDL CRYOABLAT PEARL 2.1 CX 90D FPRPR3601","code_information":[{"code":"Px0000805636L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NDL CRYOABLAT SPHR 1.5 CX 90D  FPRPR3573","code_information":[{"code":"Px0000805637L","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 2CMX4CM AMNIOBAND WC3024 8SQCM","code_information":[{"code":"Px0000824003L","type":"CDM"},{"code":"Q4157","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.96,"discounted_cash":236.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 4CMX4CM AMNIOBAND WC3044","code_information":[{"code":"Px0000824056L","type":"CDM"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 4CMX6CM AMNIOBAND WC3046","code_information":[{"code":"Px0000824081L","type":"CDM"},{"code":"Q4161","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 2CMX2CM AMNIOBAND WC3022 4SQCM","code_information":[{"code":"Px0000825916L","type":"CDM"},{"code":"Q4151","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.58,"discounted_cash":404.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ELCTRD HEADBAND EEG CERIBELL DISP NTAP","code_information":[{"code":"Px0000827254L","type":"CDM"}],"standard_charges":[{"gross_charge":1587.65,"discounted_cash":1190.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 3CMX4CM AMNIOBAND WC3034 12SQCM","code_information":[{"code":"Px0000827391L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":176.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TRAY PICC 4FR DUAL LUMEN MAX B S1294108D2","code_information":[{"code":"Px0000829379L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":594.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT STRAVIX 2X4CM 8SQCM PS61024","code_information":[{"code":"Px0000833064L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.95,"discounted_cash":442.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH KIT PERIVAC PIGTAIL US M004PERIVAC1P0","code_information":[{"code":"Px0000834572L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC STENT PROSTATIC TEMP IMP WA2ITA00","code_information":[{"code":"Px0000842858L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6811.35,"discounted_cash":5108.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PERCLOSE PROSTYLE 1277303","code_information":[{"code":"Px0000842866L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":406.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT ACC CRAN VENT W/O LIDO 46154","code_information":[{"code":"Px0000843369L","type":"CDM"},{"code":"843369L","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT EPICORD 1X2CM EC-5120 2SQCM","code_information":[{"code":"Px0000847490L","type":"CDM"},{"code":"Q4187","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.74,"discounted_cash":934.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SET BEQ-HLS ADV 7050 7.0 701069078","code_information":[{"code":"Px0000868333L","type":"CDM"}],"standard_charges":[{"gross_charge":33514.0,"discounted_cash":25135.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH HEMO 13FR 15CM CRV DUAL","code_information":[{"code":"Px0000868422L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.93,"discounted_cash":302.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC DEV BIOP BIOPINCE ULTRA FULL 18X10 360108002","code_information":[{"code":"Px0000870772L","type":"CDM"}],"standard_charges":[{"gross_charge":174.63,"discounted_cash":130.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP SECURMARK TOP HAT","code_information":[{"code":"Px0000873668L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":110.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP MRI SS SHP 1 SMARKMSS1","code_information":[{"code":"Px0000873673L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BX SECURMARK INFINITY SMARKUSS2","code_information":[{"code":"Px0000873674L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.48,"discounted_cash":73.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BIOP EVIVA 13GA TRIMARKEVIVA13","code_information":[{"code":"Px0000873679L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH DLYS 13FR 12.5CM CRV DUAL 5626120","code_information":[{"code":"Px0000874618L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC ALGRFT MATRIX HD 5MM 4X6CM 24SQCM TDT546","code_information":[{"code":"Px0000879547L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.66,"discounted_cash":277.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MATRIX HEMOSTATIC WITH RECOTHROM FLOSEAL 5ML ADS202105","code_information":[{"code":"Px0001001561L","type":"CDM"}],"standard_charges":[{"gross_charge":414.56,"discounted_cash":310.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER INTRA AORTIC BALLOON 0.025IN REDIGUARD 8FRX40CC IABS840C","code_information":[{"code":"Px0001001717L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":626.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK CONIC 18G X 10CM 351260","code_information":[{"code":"Px0001002149L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.81,"discounted_cash":175.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC TUMARK CONIC 18G X 12CM 351262","code_information":[{"code":"Px0001002194L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.81,"discounted_cash":175.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER BALLOON PERIPHERAL RX ENROUTE ENFLATE SR5525BC 5.5X25MM","code_information":[{"code":"Px0001003795L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 3X3.5CM FATTY ACIDS GRAFT WOUND DRSG 50200S01B2D 11SQCM","code_information":[{"code":"Px0001005408L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 5X7CM FATTY ACIDS GRAFT WOUND DRSG 50200S05B2D 35SQCM","code_information":[{"code":"Px0001005430L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":74.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 3X7CM FATTY ACIDS GRAFT WOUND DRSG 50200S0 21SQCM","code_information":[{"code":"Px0001005431L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 16MM FATTY ACIDS GRAFT WOUND DRSG 50200S16B2D 2SQCM","code_information":[{"code":"Px0001005432L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.6,"discounted_cash":805.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KERECIS OMEGA3 1.75X1.75CM FATTY ACIDS GRAFT WOUND DRESSING 50200S00B2D","code_information":[{"code":"Px0001005438L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT DEV INTRAUTERINE HEMORRHAGE JADA 1047196 CDM","code_information":[{"code":"Px0001007757L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3587.15,"discounted_cash":2690.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC REFLECTOR DELIVERY SYSTEM MARKER SCOUT BX 15GAX12.3CM SSR13B-01","code_information":[{"code":"Px0001012349L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.84,"discounted_cash":977.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC NEEDLE PROC LOC SINGLE HAND MINI SCOUT SSR75SM01 7.5CM","code_information":[{"code":"Px0001012500L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MILK HUMAN PROLACT RTF 24 100ML 95024100","code_information":[{"code":"Px0001012655L","type":"CDM"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SEALANT HEMOSTATIC NON ANTIMICROBIAL FLOSEAL COLLGN 10ML ADS202110","code_information":[{"code":"Px0001016602L","type":"CDM"}],"standard_charges":[{"gross_charge":711.24,"discounted_cash":533.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC HEMOSTAT SURGICEL OXIDIZED REG CELLULOSE ABSORB ORIGINAL 2X14IN","code_information":[{"code":"Px0001017434L","type":"CDM"}],"standard_charges":[{"gross_charge":377.99,"discounted_cash":283.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE MARROW NDL TREK TKM1115 11GAX15CM","code_information":[{"code":"Px0001061586L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.36,"discounted_cash":334.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE MARROW NDL TREK TKM1110 11GAX10CM","code_information":[{"code":"Px0001061593L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.36,"discounted_cash":334.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE VASCULAR STRAIGHT TIP SPLASHWIRE MSWSTDS35180 0.035INX180CM","code_information":[{"code":"Px0001062994L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.84,"discounted_cash":78.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GUIDEWIRE VASCULAR ANGLED TIP SPLASHWIRE MSWSTDA35150 0.035INX150CM","code_information":[{"code":"Px0001063008L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.28,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 13GAX6CM NEEDLE TREK TKL1106 11GAX 6CM","code_information":[{"code":"Px0001073674L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 11GAX10CM NEEDLE TREK TKL110 11GAX10CM","code_information":[{"code":"Px0001073679L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 12GX10.8CM NEEDLE TREK TKL1006 10GAX6CM","code_information":[{"code":"Px0001073680L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 12GX19.8CM NEEDLE TREK TKL1015 10GAX15CM","code_information":[{"code":"Px0001073697L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION 11GAX15CM NEEDLE TREK TKL1115 11GA X 15CM","code_information":[{"code":"Px0001073698L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT BIOPSY BONE LESION LOW HIGH SPEED TREK TKL1010 10GAX10CM","code_information":[{"code":"Px0001073713L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.05,"discounted_cash":711.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH VENOUS ARTERIAL BIO MEDICUS 27FRX61CM LS LS96360027","code_information":[{"code":"Px0001074172L","type":"CDM"}],"standard_charges":[{"gross_charge":1573.6,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH VENOUS/ARTERIAL BIO MEDICUS LIFE SUPPORT LS96555021 21FRX55CM","code_information":[{"code":"Px0001074178L","type":"CDM"}],"standard_charges":[{"gross_charge":1475.25,"discounted_cash":1106.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATH VENOUS ARTERIAL BIO MEDICUS 25FRX55CM LS LS96555025","code_information":[{"code":"Px0001074179L","type":"CDM"}],"standard_charges":[{"gross_charge":1475.25,"discounted_cash":1106.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT BIO SOFT TISSUE RECTANGLE SURGICLOSE 50205N20D0D 4X6CM 24SQCM","code_information":[{"code":"Px0001079669L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.91,"discounted_cash":140.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PINK 5CM","code_information":[{"code":"Px0001079738L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PINK 7.5CM","code_information":[{"code":"Px0001079739L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PINK 10CM","code_information":[{"code":"Px0001079740L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM GREEN 5CM","code_information":[{"code":"Px0001079741L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM GREEN 7.5CM","code_information":[{"code":"Px0001079742L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM GREEN 10CM","code_information":[{"code":"Px0001079743L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.6,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PURPLE 5CM","code_information":[{"code":"Px0001079744L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PURPLE 7.5CM","code_information":[{"code":"Px0001079745L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC SMARTCLIP SOFT TISSUE MARKER AND DELIVERY SYSTEM PURPLE 10CM","code_information":[{"code":"Px0001079746L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 3CMX8CM AMNIOBAND WC3038","code_information":[{"code":"Px0001080193L","type":"CDM"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":211.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 7CMX7CM AMNIOBAND WC3077","code_information":[{"code":"Px0001080197L","type":"CDM"},{"code":"Q4163","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":320.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 14MM AMNIOBAND 1.5SQCM WC3014","code_information":[{"code":"Px0001080204L","type":"CDM"},{"code":"Q4152","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 10MM AMNIOBAND 1SQCM WC3010","code_information":[{"code":"Px0001080208L","type":"CDM"},{"code":"Q4151","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 18MM AMNIOBAND WC3018 3SQCM","code_information":[{"code":"Px0001080217L","type":"CDM"},{"code":"Q4154","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.06,"discounted_cash":332.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 2CMX3CM AMNIOBAND WC3023 12SQCM","code_information":[{"code":"Px0001080223L","type":"CDM"},{"code":"Q4156","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.99,"discounted_cash":147.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 16MM AMNIOBAND WC3016 2SQCM","code_information":[{"code":"Px0001080226L","type":"CDM"},{"code":"Q4153","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.3,"discounted_cash":454.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MEMBRANE 5CMX6CM AMNIOBAND WC3056","code_information":[{"code":"Px0001080228L","type":"CDM"},{"code":"Q4162","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BREAST BIOPSY LOCALIZATION THRD W TUFLEX NIT 18GAX5CM 271640","code_information":[{"code":"Px0001081572L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.41,"discounted_cash":559.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC MARKER BREAST BIOPSY LOCALIZATION THRD W TUFLEX NIT 18GAX7.5CM 271641","code_information":[{"code":"Px0001081580L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.41,"discounted_cash":559.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC PROSTHESIS URO PROSTATE SCULPTABLE SPACER CUSTOM KIT BARRIGEL 10263069","code_information":[{"code":"Px0001081619L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7888.0,"discounted_cash":5916.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT BIOLOGICAL SOFT TISSUE RECTANGLE ULTRA OASIS 8213100037 3X7 CM","code_information":[{"code":"Px0001093171L","type":"CDM"},{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.73,"discounted_cash":22.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC GRAFT BIOLGCL SOFT TISS RECTANGLE ULTRAOASIS 8213100033 3X3.5CM 10.5SQCM","code_information":[{"code":"Px0001093172L","type":"CDM"},{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.41,"discounted_cash":22.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT THERAPY DRESSING PEEL AND PLACE LG SEVEN VAC EZ5LRG.S 26X35.6CM","code_information":[{"code":"Px0001100843L","type":"CDM"}],"standard_charges":[{"gross_charge":447.82,"discounted_cash":335.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT THERAPY DRESSING PEEL AND PLACE MED VAC EZ5MED.S 23.7X29.2CM","code_information":[{"code":"Px0001100848L","type":"CDM"}],"standard_charges":[{"gross_charge":294.29,"discounted_cash":220.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC KIT THERAPY DRESSING PEEL AND PLACE SM SEVEN VAC EZ5SML.S 16.9X20.6CM","code_information":[{"code":"Px0001100852L","type":"CDM"}],"standard_charges":[{"gross_charge":364.61,"discounted_cash":273.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER CENTRAL VENOUS POWERPICC PROVENA SOLO S1294108D6 4FRX55CM","code_information":[{"code":"Px0001111767L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.41,"discounted_cash":663.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CATHETER CENTRAL VENOUS POWERPICC PROVENA SOLO S1193108D6 3FRX55CM","code_information":[{"code":"Px0001111772L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.34,"discounted_cash":646.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC R&B-SEMI-PRIVATE","code_information":[{"code":"Px00012010001","type":"CDM"}],"standard_charges":[{"gross_charge":4135.0,"discounted_cash":3101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE SWING BED","code_information":[{"code":"Px00012010004","type":"CDM"}],"standard_charges":[{"gross_charge":4135.0,"discounted_cash":3101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG W/ TELE","code_information":[{"code":"Px00012010009","type":"CDM"}],"standard_charges":[{"gross_charge":3901.0,"discounted_cash":2925.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ISOLATION","code_information":[{"code":"Px00012010011","type":"CDM"}],"standard_charges":[{"gross_charge":5790.0,"discounted_cash":4342.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG TELEMETRY ISOLATION","code_information":[{"code":"Px00012010024","type":"CDM"}],"standard_charges":[{"gross_charge":5413.0,"discounted_cash":4059.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED/SURG GYN","code_information":[{"code":"Px00012110001","type":"CDM"}],"standard_charges":[{"gross_charge":4135.0,"discounted_cash":3101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B- SEMI-PRIVATE ED BOARDER","code_information":[{"code":"Px00012110005","type":"CDM"}],"standard_charges":[{"gross_charge":4135.0,"discounted_cash":3101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB","code_information":[{"code":"Px00012210001","type":"CDM"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":3476.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PEDIATRIC ISOLATION","code_information":[{"code":"Px00012310002","type":"CDM"}],"standard_charges":[{"gross_charge":7017.0,"discounted_cash":5262.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OTHER W/TELEMETRY","code_information":[{"code":"Px00012910002","type":"CDM"}],"standard_charges":[{"gross_charge":4135.0,"discounted_cash":3101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OTHER SWING BED","code_information":[{"code":"Px00012910003","type":"CDM"}],"standard_charges":[{"gross_charge":4135.0,"discounted_cash":3101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B- SEMI-PRIVATE MED SURG GYN PACU DC WARD","code_information":[{"code":"Px00013110002","type":"CDM"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":880.0,"discounted_cash":660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY ROUTINE CARE","code_information":[{"code":"Px00017010001","type":"CDM"}],"standard_charges":[{"gross_charge":2582.0,"discounted_cash":1936.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 2","code_information":[{"code":"Px00017210001","type":"CDM"}],"standard_charges":[{"gross_charge":6735.0,"discounted_cash":5051.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY BOARDER","code_information":[{"code":"Px00017910002","type":"CDM"}],"standard_charges":[{"gross_charge":2582.0,"discounted_cash":1936.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS WA CDM","code_information":[{"code":"Px00019110002","type":"CDM"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE","code_information":[{"code":"Px00020010001","type":"CDM"}],"standard_charges":[{"gross_charge":7979.0,"discounted_cash":5984.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-ICU ISOLATION","code_information":[{"code":"Px00020010011","type":"CDM"}],"standard_charges":[{"gross_charge":7979.0,"discounted_cash":5984.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE INTERMEDIATE","code_information":[{"code":"Px00020610001","type":"CDM"}],"standard_charges":[{"gross_charge":3901.0,"discounted_cash":2925.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC R&B-INTERMEDIATE/TELEMETRY ISOLATION","code_information":[{"code":"Px00020610003","type":"CDM"}],"standard_charges":[{"gross_charge":5413.0,"discounted_cash":4059.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":218.0,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW PICC OR NONIMPLANTED CENTRAL LINE CDM","code_information":[{"code":"Px00026010006","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00026010007","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":309.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION EACH ADDL HR CDM","code_information":[{"code":"Px00026010008","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00026010009","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION EA ADDL HR CDM","code_information":[{"code":"Px00026010010","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION SEQUENTIAL DRUG 1ST HR","code_information":[{"code":"Px00026010011","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION CONCURRENT DRUG CDM","code_information":[{"code":"Px00026010012","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":145.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC WRIST SPLINT/VELCRO","code_information":[{"code":"Px00027410120","type":"CDM"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC OT EO  W/ JOINTS  CUSTOM","code_information":[{"code":"Px00027410136","type":"CDM"},{"code":"L3730","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EWHO RIGID NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410237","type":"CDM"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":432.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EWHFO RIGID NO JOINTS CSTM","code_information":[{"code":"Px00027410239","type":"CDM"},{"code":"L3765","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":585.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":526.0,"discounted_cash":394.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC WHFO RIGID  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410241","type":"CDM"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":544.0,"discounted_cash":408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HFO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410243","type":"CDM"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HAND ORTHOTIC -  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410244","type":"CDM"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410246","type":"CDM"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FO  W/JOINTS  CUSTOM","code_information":[{"code":"Px00027410247","type":"CDM"},{"code":"L3935","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC WHO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410269","type":"CDM"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000004","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID LAB","code_information":[{"code":"Px00030000006","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000007","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000008","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE","code_information":[{"code":"Px00030010002","type":"CDM"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":96.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC BLOOD DRAW VENIPUNCTURE CDM","code_information":[{"code":"Px00030010004","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":25.0,"discounted_cash":18.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM","code_information":[{"code":"Px00030010009","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COLLECTION CAPILLARY BLOOD SPECIMEN","code_information":[{"code":"Px00030010011","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":350.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":288.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030010228","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL","code_information":[{"code":"Px00030010256","type":"CDM"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":342.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":460.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":288.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":848.0,"discounted_cash":636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANA TITER IGG REFLEX (ARUP)","code_information":[{"code":"Px00030010416","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSOC AB - HIT (ARUP)","code_information":[{"code":"Px00030010418","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM","code_information":[{"code":"Px00030010421","type":"CDM"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BETA2 GLYCOPROT AB IGG (OF PNL)","code_information":[{"code":"Px00030010424","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C-1-ESTERASE INHIB FUNC(ARUP)","code_information":[{"code":"Px00030010431","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT CDM","code_information":[{"code":"Px00030010433","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT CH50 TOTAL(ARUP)","code_information":[{"code":"Px00030010434","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CCP AB IGG","code_information":[{"code":"Px00030010443","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EBV AB VIRAL CAPSID AG IGM","code_information":[{"code":"Px00030010455","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EBV AB VIRAL CAPSID AG IGG","code_information":[{"code":"Px00030010462","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLOM BASEMENT MEMB AB IGG(ARUP)","code_information":[{"code":"Px00030010470","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010472","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN AB","code_information":[{"code":"Px00030010478","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - NONINFEC AGENT","code_information":[{"code":"Px00030010485","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR CA 19-9","code_information":[{"code":"Px00030010558","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHROMOGRANIN A (ARUP)","code_information":[{"code":"Px00030010568","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNE COMPLEX ASSAY CDM","code_information":[{"code":"Px00030010589","type":"CDM"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A (PANL)","code_information":[{"code":"Px00030010613","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A (ARUP)","code_information":[{"code":"Px00030010615","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INSULIN ANTIBODIES CDM","code_information":[{"code":"Px00030010617","type":"CDM"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EBV AB NUCLEAR AG IGG","code_information":[{"code":"Px00030010619","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY IGG(ARUP)","code_information":[{"code":"Px00030010621","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00030010623","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROID PEROXIDASE AB (ANTI-TPO)","code_information":[{"code":"Px00030010634","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010661","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TB INTRADERMAL TEST - PPD","code_information":[{"code":"Px00030010683","type":"CDM"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LYME IGM W BLOT(PANL)","code_information":[{"code":"Px00030010720","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST CDM","code_information":[{"code":"Px00030010722","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LYME IGG W BLOT(PANL)","code_information":[{"code":"Px00030010723","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC B BURGDORFERI AB TOTAL (ARUP)","code_information":[{"code":"Px00030010730","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA CDM","code_information":[{"code":"Px00030010736","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CMV IGM","code_information":[{"code":"Px00030010762","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HTLV I - II AB W BLOT (ARUP)","code_information":[{"code":"Px00030010870","type":"CDM"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEP B CORE IGM ANTIBODY","code_information":[{"code":"Px00030010892","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PARVOVIRUS CDM","code_information":[{"code":"Px00030010894","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HIV- 2","code_information":[{"code":"Px00030010922","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010931","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA IGM (PANL)","code_information":[{"code":"Px00030010944","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PARVOVIRUS IGM (PANL)","code_information":[{"code":"Px00030010954","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PARVOVIRUS IGG (PANL)","code_information":[{"code":"Px00030010955","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MEASLES (RUBEOLA) AB IGM (ARUP)","code_information":[{"code":"Px00030010968","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TOXO GONDII AB IGG(ARUP)","code_information":[{"code":"Px00030010983","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TOXO GONDII AB IGM (PANL)","code_information":[{"code":"Px00030010993","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MHA-TP CONFIRMATION REFLX (ARUP)","code_information":[{"code":"Px00030010997","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FTA-ABS (ARUP)","code_information":[{"code":"Px00030010998","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TREPONEMA PALLIDUM - AB","code_information":[{"code":"Px00030010999","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - IGG","code_information":[{"code":"Px00030011003","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011004","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VARICELLA ZOSTER ANTIBODY","code_information":[{"code":"Px00030011005","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES","code_information":[{"code":"Px00030011023","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY CDM","code_information":[{"code":"Px00030011045","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ LAB","code_information":[{"code":"Px00030011050","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DIRECT COOMBS","code_information":[{"code":"Px00030011070","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO LAB","code_information":[{"code":"Px00030011083","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011098","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS","code_information":[{"code":"Px00030011114","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN LAB","code_information":[{"code":"Px00030011123","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ELECTRONIC LAB","code_information":[{"code":"Px00030011125","type":"CDM"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":161.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES SMEARS","code_information":[{"code":"Px00030011200","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ACID FAST STAIN","code_information":[{"code":"Px00030011241","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRYPTOCOCCUS NEOFORM AG EIA","code_information":[{"code":"Px00030011352","type":"CDM"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANA IGG REFLEX (ARUP)","code_information":[{"code":"Px00030011373","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC B BURGDORFERI PCR (ARUP)","code_information":[{"code":"Px00030011418","type":"CDM"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL TRANSCUTANEOUS CDM","code_information":[{"code":"Px00030011424","type":"CDM"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA BK VIRUS QUANTIFICATION EACH ORGANISM CDM","code_information":[{"code":"Px00030011426","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS QUANT PCR (ARUP)","code_information":[{"code":"Px00030011427","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN FOOD HAZELNUT (ARUP)","code_information":[{"code":"Px00030011435","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN FOOD CASHEW (ARUP)","code_information":[{"code":"Px00030011438","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN WALNUT (ARUP)","code_information":[{"code":"Px00030011444","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN ALMOND (ARUP)","code_information":[{"code":"Px00030011445","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN PECAN (ARUP)","code_information":[{"code":"Px00030011451","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C-1-ESTERASE INHIBITOR(ARUP)","code_information":[{"code":"Px00030011484","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN DIPTHERIA CDM","code_information":[{"code":"Px00030011501","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL","code_information":[{"code":"Px00030011502","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030011511","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CANDIDA SPECIES DNA PROBE(PANL)","code_information":[{"code":"Px00030011541","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA CYTOMEGALOVIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030011582","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS","code_information":[{"code":"Px00030011594","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011610","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN BARR VIRUS BY PCR","code_information":[{"code":"Px00030011612","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA EPSTEIN BARR QUANTIFICATION EA ORG CDM","code_information":[{"code":"Px00030011613","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":129.66,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":267.97,"discounted_cash":200.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GARDNERELLA VAG DNA PROBE(PANL)","code_information":[{"code":"Px00030011638","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM","code_information":[{"code":"Px00030011653","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION AMPLIFIED PROBE","code_information":[{"code":"Px00030011693","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION PCR","code_information":[{"code":"Px00030011694","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A CDM","code_information":[{"code":"Px00030011698","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011703","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011709","type":"CDM"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011710","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP A LAB","code_information":[{"code":"Px00030011741","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":53.0,"discounted_cash":39.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ELUTION RBC EACH ELUTION LAB","code_information":[{"code":"Px00030011742","type":"CDM"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM CDM","code_information":[{"code":"Px00030011752","type":"CDM"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC STREP PNEUMO ANTIGEN","code_information":[{"code":"Px00030011761","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HLA-B27","code_information":[{"code":"Px00030011856","type":"CDM"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":199.0,"discounted_cash":149.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00030011868","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CMV IGG","code_information":[{"code":"Px00030011874","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EBV AB TO EARLY (D) AG IGG","code_information":[{"code":"Px00030011882","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030011886","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SCL-70 AB IGG(ARUP)","code_information":[{"code":"Px00030011905","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACOSAMIND SERUM OR PLASMA","code_information":[{"code":"Px00030011992","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HCIMMUNOASSAY ANALYTE QUANTITATIVE","code_information":[{"code":"Px00030011994","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030012037","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LYME IGM BY WESTERN BLOT","code_information":[{"code":"Px00030012171","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PRO BNP","code_information":[{"code":"Px00030012211","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CPK ISOENZYMES","code_information":[{"code":"Px00030012275","type":"CDM"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TB AG RESPONSE T-CELL SUSP","code_information":[{"code":"Px00030012379","type":"CDM"},{"code":"86481","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":258.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URINE PREGNANCY TEST","code_information":[{"code":"Px00030013001","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":25.0,"discounted_cash":18.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC CERULOPLASMIN CDM","code_information":[{"code":"Px00030013004","type":"CDM"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE","code_information":[{"code":"Px00030013005","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD OTHER SOURCES","code_information":[{"code":"Px00030013006","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC CDM","code_information":[{"code":"Px00030013008","type":"CDM"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM","code_information":[{"code":"Px00030013009","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030013010","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF C-PEPTIDE","code_information":[{"code":"Px00030013013","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":80.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ADRENOCORTICOTROPIC HORMONE ACTH CDM","code_information":[{"code":"Px00030013018","type":"CDM"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOLASE CDM","code_information":[{"code":"Px00030013019","type":"CDM"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IGE","code_information":[{"code":"Px00030013033","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":63.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE","code_information":[{"code":"Px00030013047","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SELENIUM CDM","code_information":[{"code":"Px00030013049","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH CDM","code_information":[{"code":"Px00030013075","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) CDM","code_information":[{"code":"Px00030013086","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL OTHER SOURCE","code_information":[{"code":"Px00030013090","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PREGNENOLONE CDM","code_information":[{"code":"Px00030013109","type":"CDM"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030013138","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TREPONEMAL AB","code_information":[{"code":"Px00030013140","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOL REC MOD AB RLFX(ARUP)","code_information":[{"code":"Px00030013143","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ACTH (ARUP)","code_information":[{"code":"Px00030013145","type":"CDM"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AFP (ARUP)","code_information":[{"code":"Px00030013146","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALDOLASE (ARUP)","code_information":[{"code":"Px00030013147","type":"CDM"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE URINE(ARUP)","code_information":[{"code":"Px00030013148","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE(ARUP)","code_information":[{"code":"Px00030013149","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ANDROSTENEDIONE","code_information":[{"code":"Px00030013155","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN CONVERT ENZYME(ARUP)","code_information":[{"code":"Px00030013156","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC APC RESISTANCE PROFILE (ARUP)","code_information":[{"code":"Px00030013157","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARSENIC FRACT URINE RFLX ARUP","code_information":[{"code":"Px00030013159","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARSENIC URINE(ARUP)","code_information":[{"code":"Px00030013160","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BETA-2 MICROGLOBULIN SERUM (ARUP)","code_information":[{"code":"Px00030013165","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILE ACIDS FRACTIONATED (ARUP)","code_information":[{"code":"Px00030013166","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COPPER URINE (ARUP)","code_information":[{"code":"Px00030013175","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COPPER(ARUP)","code_information":[{"code":"Px00030013176","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL URINE FREE (ARUP)","code_information":[{"code":"Px00030013177","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DHEA (ARUP)","code_information":[{"code":"Px00030013179","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTROGENS FRACTIONATED TMS(ARUP)","code_information":[{"code":"Px00030013180","type":"CDM"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTRONE TMS(ARUP)","code_information":[{"code":"Px00030013181","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FRUCTOSAMINE(ARUP)","code_information":[{"code":"Px00030013185","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GASTRIN(ARUP)","code_information":[{"code":"Px00030013187","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLIADIN AB IGA","code_information":[{"code":"Px00030013188","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE-6-PHOSPHATE DEHYD(ARUP)","code_information":[{"code":"Px00030013190","type":"CDM"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GROWTH HORMONE (ARUP)","code_information":[{"code":"Px00030013192","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN A1C (CONFIRM)(ARUP)","code_information":[{"code":"Px00030013193","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HGB A2 AND F BY COLUMN (ARUP)","code_information":[{"code":"Px00030013194","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEAD WHOLE BLOOD","code_information":[{"code":"Px00030013199","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MERCURY BLOOD(ARUP)","code_information":[{"code":"Px00030013203","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MERCURY URINE (ARUP)","code_information":[{"code":"Px00030013204","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES PLASMA (ARUP)","code_information":[{"code":"Px00030013205","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES URINE(ARUP)","code_information":[{"code":"Px00030013206","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC N-TELOPEPTIDE X-LINK URINE(ARUP)","code_information":[{"code":"Px00030013213","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RENIN ACTIVITY(ARUP)","code_information":[{"code":"Px00030013221","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SEROTONIN (ARUP)","code_information":[{"code":"Px00030013222","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROID STIM IMMUNOGLOB(ARUP)","code_information":[{"code":"Px00030013229","type":"CDM"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TOPIRAMATE(ARUP)","code_information":[{"code":"Px00030013231","type":"CDM"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TRIIODTHYRONINE REVERSE (ARUP)","code_information":[{"code":"Px00030013232","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TRYPTASE (ARUP)","code_information":[{"code":"Px00030013233","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VISCOSITY SERUM(ARUP)","code_information":[{"code":"Px00030013234","type":"CDM"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VITAMIN A (RETINOL) (ARUP)","code_information":[{"code":"Px00030013235","type":"CDM"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B6 (PYRIDOX 5 PHOS)(ARUP)","code_information":[{"code":"Px00030013236","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VITAMIN D 1 25-DIHYDROXY","code_information":[{"code":"Px00030013237","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VITAMIN E (ARUP)","code_information":[{"code":"Px00030013239","type":"CDM"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZACETYLCHOLINE BIND AB(PANL)","code_information":[{"code":"Px00030013584","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZACETYLCHOLINE BLOCK AB(PANL)","code_information":[{"code":"Px00030013585","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZAFP(PANL)","code_information":[{"code":"Px00030013593","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZALBUMIN CSF (PANL)","code_information":[{"code":"Px00030013594","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZALBUMIN SERUM (PANL)","code_information":[{"code":"Px00030013595","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZALKP ISOENZYMES (PANL)","code_information":[{"code":"Px00030013597","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZALKP TOTAL (PANL)","code_information":[{"code":"Px00030013598","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZALPHA-1-ANTITRYPSIN (PANL)","code_information":[{"code":"Px00030013599","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZALPHA-1-ANTITRYPSIN PHENO(PANL)","code_information":[{"code":"Px00030013600","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZARSENIC BLOOD (PANL)","code_information":[{"code":"Px00030013612","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZCK ISOENZYMES (PANL)","code_information":[{"code":"Px00030013631","type":"CDM"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZCK TOTAL (PANL)","code_information":[{"code":"Px00030013632","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZDRVVT (PANL)","code_information":[{"code":"Px00030013642","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZESTRIOL(PANL)","code_information":[{"code":"Px00030013651","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZF8 (PANL)","code_information":[{"code":"Px00030013652","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZFACTOR VIII ACTIVITY (ARUP)","code_information":[{"code":"Px00030013653","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZFOLATE RBC (ARUP)","code_information":[{"code":"Px00030013657","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZGM1 AB IGG (PANL)","code_information":[{"code":"Px00030013665","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZGM1 AB IGM (PANL)","code_information":[{"code":"Px00030013666","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZHCG(PANL)","code_information":[{"code":"Px00030013670","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 1 (PANL)","code_information":[{"code":"Px00030013682","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":164.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 2 (PANL)","code_information":[{"code":"Px00030013683","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":164.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 3 (PANL)","code_information":[{"code":"Px00030013684","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":164.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZIGG SUBCLASS 4 (PANL)","code_information":[{"code":"Px00030013685","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":164.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZIMMUNOGLOBULINS (PANL)","code_information":[{"code":"Px00030013692","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZINC SERUM(ARUP)","code_information":[{"code":"Px00030013694","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZLEAD BLOOD(PANL)","code_information":[{"code":"Px00030013711","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZMERCURY BLOOD (PANL)","code_information":[{"code":"Px00030013715","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZMYELOPEROXIDASE AB(MPO)(ARUP)","code_information":[{"code":"Px00030013722","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZPHENOBARBITAL (ARUP)","code_information":[{"code":"Px00030013730","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZPT-D (PANL)","code_information":[{"code":"Px00030013737","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZPTT-D (PANL)","code_information":[{"code":"Px00030013740","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZSERINE PROTEASE 3 AB(PR3)(ARUP)","code_information":[{"code":"Px00030013746","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZT3 UPTAKE (PANL)","code_information":[{"code":"Px00030013748","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZT3 UPTAKE(ARUP)","code_information":[{"code":"Px00030013749","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZT4 (PANL)","code_information":[{"code":"Px00030013750","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZT4 FREE BY EQUIL DIALYSIS(ARUP)","code_information":[{"code":"Px00030013751","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZVWF AG (PANL)","code_information":[{"code":"Px00030013767","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZVWF (PANL)","code_information":[{"code":"Px00030013771","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CALPROTECTIN FECAL CDM","code_information":[{"code":"Px00030013774","type":"CDM"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":186.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYPROGESTERONE 17-D CDM","code_information":[{"code":"Px00030013811","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00030013840","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030013881","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA CDM","code_information":[{"code":"Px00030013905","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE CDM","code_information":[{"code":"Px00030013912","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":60.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME 85610","code_information":[{"code":"Px00030013952","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS CDM","code_information":[{"code":"Px00030013969","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SODIUM","code_information":[{"code":"Px00030013978","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR CDM","code_information":[{"code":"Px00030013979","type":"CDM"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRVVT","code_information":[{"code":"Px00030014048","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014052","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030014053","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00030014072","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014112","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE BLD","code_information":[{"code":"Px00030014129","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE CDM","code_information":[{"code":"Px00030014132","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALKALINE PHOS","code_information":[{"code":"Px00030014138","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME CDM","code_information":[{"code":"Px00030014236","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC CDM","code_information":[{"code":"Px00030014290","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014481","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CAROTENE CDM","code_information":[{"code":"Px00030014498","type":"CDM"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030014520","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY","code_information":[{"code":"Px00030014538","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030014558","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CK TOTAL","code_information":[{"code":"Px00030014566","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COLUMN CHROMOTOGRAPHY QUANT","code_information":[{"code":"Px00030014590","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER CDM","code_information":[{"code":"Px00030014603","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030014605","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE TOTAL CDM","code_information":[{"code":"Px00030014625","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DDIMER QUANT","code_information":[{"code":"Px00030014674","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE CDM","code_information":[{"code":"Px00030014683","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED CDM","code_information":[{"code":"Px00030014690","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTRADIOL","code_information":[{"code":"Px00030014796","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTRIOL LEVEL","code_information":[{"code":"Px00030014801","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ETHYLENE GLYCOL LEVEL","code_information":[{"code":"Px00030014810","type":"CDM"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FACTOR 8","code_information":[{"code":"Px00030014823","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM","code_information":[{"code":"Px00030014877","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN CDM","code_information":[{"code":"Px00030014881","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID RBC CDM","code_information":[{"code":"Px00030014899","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00030014933","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLYCATED PROTEIN CDM","code_information":[{"code":"Px00030014936","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE CDM","code_information":[{"code":"Px00030014945","type":"CDM"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GASTRIN CDM","code_information":[{"code":"Px00030014962","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GGT GLUTAMYTRANSFERASE GAMMA","code_information":[{"code":"Px00030014969","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)","code_information":[{"code":"Px00030014986","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00030015029","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE CDM","code_information":[{"code":"Px00030015043","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT (HCT)","code_information":[{"code":"Px00030015067","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT SPUN-MISC FLUID","code_information":[{"code":"Px00030015068","type":"CDM"},{"code":"85013","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015078","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN (HGB)","code_information":[{"code":"Px00030015080","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030015085","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN CDM","code_information":[{"code":"Px00030015086","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT HUMAN ANTI MOUSE AB CDM","code_information":[{"code":"Px00030015187","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - ARSENIC","code_information":[{"code":"Px00030015188","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - LEAD","code_information":[{"code":"Px00030015190","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - MERCURY","code_information":[{"code":"Px00030015191","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - ARSENIC","code_information":[{"code":"Px00030015192","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - LEAD","code_information":[{"code":"Px00030015194","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - MERCURY","code_information":[{"code":"Px00030015195","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT IGF BP3 CDM","code_information":[{"code":"Px00030015217","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015229","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015258","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":164.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IRON BINDING CAPACITY CDM","code_information":[{"code":"Px00030015300","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS CDM","code_information":[{"code":"Px00030015351","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030015357","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN CDM","code_information":[{"code":"Px00030015370","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CDM","code_information":[{"code":"Px00030015371","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LDH SERUM","code_information":[{"code":"Px00030015373","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM QUANT URINE","code_information":[{"code":"Px00030015421","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MERCURY QUANT BLOOD","code_information":[{"code":"Px00030015440","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015448","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NI METABOLIC SCREEN CDM","code_information":[{"code":"Px00030015575","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NMR-LIPOPROTEIN PAR QNT & SUBCLASSES","code_information":[{"code":"Px00030015580","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PH GASTRIC CDM","code_information":[{"code":"Px00030015674","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE BLOOD","code_information":[{"code":"Px00030015717","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030015745","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PRENATAL-ESTRIOL","code_information":[{"code":"Px00030015746","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM","code_information":[{"code":"Px00030015747","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015761","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE PAMC","code_information":[{"code":"Px00030015783","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00030015823","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA CDM","code_information":[{"code":"Px00030015834","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM LAB","code_information":[{"code":"Px00030015863","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RENIN CDM","code_information":[{"code":"Px00030015879","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SELENIUM SERUM","code_information":[{"code":"Px00030015900","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEROTONIN","code_information":[{"code":"Px00030015924","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"Px00030015928","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SGOT / AST","code_information":[{"code":"Px00030015929","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SGPT (ALT)","code_information":[{"code":"Px00030015931","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SGPT / ALT","code_information":[{"code":"Px00030015932","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TRIIODOTHYRONINE T3 REVERSE CDM","code_information":[{"code":"Px00030015998","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN REFLEX TEST","code_information":[{"code":"Px00030016038","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROID STIMULATING IMMUNE GLOBULINS TSI CDM","code_information":[{"code":"Px00030016040","type":"CDM"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYRO-THYROGLOBULIN","code_information":[{"code":"Px00030016042","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROXINE BINDING GLOBULIN CDM","code_information":[{"code":"Px00030016043","type":"CDM"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030016086","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030016091","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE TRYPTASE CDM","code_information":[{"code":"Px00030016097","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THIAMINE-VITAMIN B-1 CDM","code_information":[{"code":"Px00030016184","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030016187","type":"CDM"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PYRIDOXAL PHOSPHATE CDM","code_information":[{"code":"Px00030016188","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030016189","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR ANTIGEN","code_information":[{"code":"Px00030016214","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00030016230","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE CELIAC CDM","code_information":[{"code":"Px00030016245","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE","code_information":[{"code":"Px00030016255","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030016259","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COBALT SERUM","code_information":[{"code":"Px00030016272","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE","code_information":[{"code":"Px00030016275","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016279","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016280","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLATELET ASSOCIATED ANTIBODY","code_information":[{"code":"Px00030016281","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00030016291","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030017035","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE FREE (ADD ON ONLY)","code_information":[{"code":"Px00030017037","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE CDM","code_information":[{"code":"Px00030017062","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE -10 11-EPOXIDE LAB","code_information":[{"code":"Px00030100041","type":"CDM"},{"code":"80161","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY SALICYLATE LAB","code_information":[{"code":"Px00030100043","type":"CDM"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100117","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100121","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100122","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM","code_information":[{"code":"Px00030100127","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL","code_information":[{"code":"Px00030100128","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE","code_information":[{"code":"Px00030100129","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME LAB","code_information":[{"code":"Px00030100132","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100137","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100140","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100143","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100162","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER LAB","code_information":[{"code":"Px00030100175","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM LAB","code_information":[{"code":"Px00030100197","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100236","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030100239","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE LAB","code_information":[{"code":"Px00030100256","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NORTRIPTYLINE LEVEL SERUM LAB","code_information":[{"code":"Px00030100350","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AMITRIPTYLINE AND NORTRIPTYLINE LEVEL LAB","code_information":[{"code":"Px00030100351","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00030100354","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLOBAZAM LAB","code_information":[{"code":"Px00030100355","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100378","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100383","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100408","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100409","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030100430","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100454","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100455","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP LAB","code_information":[{"code":"Px00030100499","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100518","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES LAB","code_information":[{"code":"Px00030100519","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE VANCOMYCIN LAB","code_information":[{"code":"Px00030100544","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100563","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100566","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100571","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030100574","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100576","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSS LINKS ANY METHOD LAB","code_information":[{"code":"Px00030100578","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100582","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100583","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100590","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100591","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100595","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL LAB","code_information":[{"code":"Px00030100598","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100606","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL LAB","code_information":[{"code":"Px00030100622","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100624","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100625","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MERCURY QUANTITATIVE LAB","code_information":[{"code":"Px00030100629","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100630","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100631","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030100632","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES LAB","code_information":[{"code":"Px00030100633","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030100651","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100652","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100657","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100658","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030100659","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100663","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100664","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100672","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYSTATIN C LAB","code_information":[{"code":"Px00030100714","type":"CDM"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSS LINKS ANY METHOD LAB","code_information":[{"code":"Px00030100716","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13 OR MORE LAB","code_information":[{"code":"Px00030100726","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP","code_information":[{"code":"Px00030100729","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030100759","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100762","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":102.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD LAB","code_information":[{"code":"Px00030100765","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100766","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100767","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100768","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100769","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":125.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100782","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100783","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030100786","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030100787","type":"CDM"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030100788","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100862","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100931","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030100932","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY LAB","code_information":[{"code":"Px00030100933","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100934","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ELECTROLYTE PANEL LAB","code_information":[{"code":"Px00030100935","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100936","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100937","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030100938","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY LAB","code_information":[{"code":"Px00030100939","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100940","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100941","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030100942","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY LAB","code_information":[{"code":"Px00030100943","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030100944","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) LAB","code_information":[{"code":"Px00030100967","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100968","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100972","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100977","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE CLEARANCE LAB","code_information":[{"code":"Px00030101030","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030101037","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 LAB","code_information":[{"code":"Px00030101038","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101047","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID RBC LAB","code_information":[{"code":"Px00030101050","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101059","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101060","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101062","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101063","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101072","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101073","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101085","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101086","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CA 15-3","code_information":[{"code":"Px00030110007","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CA 27.29","code_information":[{"code":"Px00030110008","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CA 19.9","code_information":[{"code":"Px00030110009","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEP C AB REFLEXIVE","code_information":[{"code":"Px00030110014","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030110064","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL LAB","code_information":[{"code":"Px00030110073","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID CDM","code_information":[{"code":"Px00030110077","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030110084","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030110085","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL OF NMR","code_information":[{"code":"Px00030110101","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE LAB","code_information":[{"code":"Px00030110131","type":"CDM"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUAN LEVETIRACETAM","code_information":[{"code":"Px00030110132","type":"CDM"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUANT OXCARBAZEPIN LAB","code_information":[{"code":"Px00030110134","type":"CDM"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":63.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ZONISAMIDE LAB","code_information":[{"code":"Px00030110136","type":"CDM"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":63.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUGS OF ABUSE URINE","code_information":[{"code":"Px00030110155","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTOFERRIN FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030110181","type":"CDM"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030110182","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110223","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL","code_information":[{"code":"Px00030110224","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030110254","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030110305","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP LAB","code_information":[{"code":"Px00030110583","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE PLASMA LAB","code_information":[{"code":"Px00030110584","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030110600","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"Px00030110602","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110605","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOS","code_information":[{"code":"Px00030110638","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 CDM","code_information":[{"code":"Px00030110661","type":"CDM"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE","code_information":[{"code":"Px00030110668","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING FENTANYL CDM","code_information":[{"code":"Px00030110669","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHADONE CDM","code_information":[{"code":"Px00030110673","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030110674","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPIATES 1 OR MORE","code_information":[{"code":"Px00030110676","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE","code_information":[{"code":"Px00030110680","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL LAB","code_information":[{"code":"Px00030110688","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AMYTRIPTYLINE-NOTRIPTYLINE (ARUP)","code_information":[{"code":"Px00030110697","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ETHYL GLUCURONIDE URINE","code_information":[{"code":"Px00030110701","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG CONFIRMATION THC","code_information":[{"code":"Px00030110716","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AMPHETAMINE SERUM-PLASMA(ARUP)","code_information":[{"code":"Px00030110727","type":"CDM"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ZNORTRIPTYLINE(ARUP)","code_information":[{"code":"Px00030110732","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE LAB","code_information":[{"code":"Px00030110741","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB","code_information":[{"code":"Px00030111010","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030112002","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN","code_information":[{"code":"Px00030112003","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD FECES","code_information":[{"code":"Px00030112004","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"Px00030112005","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN","code_information":[{"code":"Px00030112008","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030112009","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRANSFERRIN","code_information":[{"code":"Px00030112011","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SOMATOMEDIN LAB","code_information":[{"code":"Px00030112012","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANT","code_information":[{"code":"Px00030112013","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM","code_information":[{"code":"Px00030112014","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SODIUM BLOOD","code_information":[{"code":"Px00030112016","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROID STIMULATING HORMONE TSH","code_information":[{"code":"Px00030112017","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TACROLIMUS","code_information":[{"code":"Px00030112019","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030112022","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030112023","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE","code_information":[{"code":"Px00030112024","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030112026","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030112027","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE CREATININE","code_information":[{"code":"Px00030112028","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ACUTE PANEL","code_information":[{"code":"Px00030112029","type":"CDM"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHORIONIC GONADOTROPIN QUAL","code_information":[{"code":"Px00030112030","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"Px00030112031","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112032","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"Px00030112033","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FETAL FIBRONECTIN","code_information":[{"code":"Px00030112034","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PH BODY FLUID NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030112035","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN A LAB","code_information":[{"code":"Px00030112039","type":"CDM"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CREATININE","code_information":[{"code":"Px00030112042","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"Px00030112043","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"Px00030112044","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PREALBUMIN CDM","code_information":[{"code":"Px00030112045","type":"CDM"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL LAB","code_information":[{"code":"Px00030112050","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RENIN","code_information":[{"code":"Px00030112051","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CAROTENE","code_information":[{"code":"Px00030112052","type":"CDM"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE","code_information":[{"code":"Px00030112055","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030112057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY BLOOD","code_information":[{"code":"Px00030112058","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN TOTAL","code_information":[{"code":"Px00030112059","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030112060","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BASIC METABOLIC PANEL","code_information":[{"code":"Px00030112061","type":"CDM"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPREHEN METABOLIC PANEL","code_information":[{"code":"Px00030112062","type":"CDM"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"Px00030112063","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RENAL FUNCTION PANEL CDM","code_information":[{"code":"Px00030112064","type":"CDM"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROXINE FREE","code_information":[{"code":"Px00030112065","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST","code_information":[{"code":"Px00030112066","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00030112067","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GTT-ADDED SAMPLES","code_information":[{"code":"Px00030112068","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"Px00030112069","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00030112073","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE CDM","code_information":[{"code":"Px00030112088","type":"CDM"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY GLUCOSE BLOOD QUANT","code_information":[{"code":"Px00030112099","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00030112100","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATE (LD) (LDH) ENZYME","code_information":[{"code":"Px00030112101","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATIC FUNCTION PANEL CDM","code_information":[{"code":"Px00030112103","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALANINE AMINO (ALT) (SGPT)","code_information":[{"code":"Px00030112104","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GGT","code_information":[{"code":"Px00030112105","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD FOLIC ACID SERUM","code_information":[{"code":"Px00030112106","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY PHOSPHORUS","code_information":[{"code":"Px00030112107","type":"CDM"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030112108","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL CDM","code_information":[{"code":"Px00030112109","type":"CDM"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN","code_information":[{"code":"Px00030112110","type":"CDM"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN","code_information":[{"code":"Px00030112111","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112112","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FREE ASSAY (FT-3)","code_information":[{"code":"Px00030112114","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030112115","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LITHIUM CDM","code_information":[{"code":"Px00030112116","type":"CDM"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IRON BINDING CAPACITY LAB","code_information":[{"code":"Px00030112117","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THYROXINE TOTAL","code_information":[{"code":"Px00030112118","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB","code_information":[{"code":"Px00030112119","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE LAB","code_information":[{"code":"Px00030112120","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN CDM","code_information":[{"code":"Px00030112121","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LDH ENZYMES","code_information":[{"code":"Px00030112122","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY","code_information":[{"code":"Px00030112126","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES","code_information":[{"code":"Px00030112157","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030112158","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE","code_information":[{"code":"Px00030112159","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":60.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CK (CPK)","code_information":[{"code":"Px00030112160","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PARATHORMONE (PARATHYROID HORMONE)","code_information":[{"code":"Px00030112161","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT","code_information":[{"code":"Px00030112162","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN FREE","code_information":[{"code":"Px00030112165","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B-12","code_information":[{"code":"Px00030112166","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030112168","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE CLEARANCE TEST","code_information":[{"code":"Px00030112169","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SODIUM URINE","code_information":[{"code":"Px00030112172","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYCLOSPORINE","code_information":[{"code":"Px00030112173","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":151.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL CDM","code_information":[{"code":"Px00030112174","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TOCOPHEROL ALPHA VITAMIN E LAB","code_information":[{"code":"Px00030112175","type":"CDM"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN K LAB","code_information":[{"code":"Px00030112185","type":"CDM"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE OTHER FLUID","code_information":[{"code":"Px00030112189","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY TRIIODOTHYRONINE (T3)","code_information":[{"code":"Px00030112193","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY BLD/SERUM CHOLESTEROL","code_information":[{"code":"Px00030112194","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112195","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE","code_information":[{"code":"Px00030112217","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL CDM","code_information":[{"code":"Px00030112228","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM","code_information":[{"code":"Px00030112229","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE BODY FLUID LAB","code_information":[{"code":"Px00030112238","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030112248","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM","code_information":[{"code":"Px00030112254","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PH BODY FLUID LAB","code_information":[{"code":"Px00030112273","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM","code_information":[{"code":"Px00030112278","type":"CDM"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RIBOFLAVIN-VITAMIN B-2 LAB","code_information":[{"code":"Px00030112286","type":"CDM"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN B","code_information":[{"code":"Px00030112292","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RIA NONANTIBODY ACETYLCHOLINE BINDING AB","code_information":[{"code":"Px00030112297","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AMYLASE","code_information":[{"code":"Px00030112298","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TOTAL PROTEIN","code_information":[{"code":"Px00030112314","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDIONE LAB","code_information":[{"code":"Px00030112315","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE","code_information":[{"code":"Px00030112329","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030112330","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030112351","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030112358","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OSMOLALITY BLOOD","code_information":[{"code":"Px00030112375","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SGOT (AST)","code_information":[{"code":"Px00030112384","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MYELOPEROXIDASE AB","code_information":[{"code":"Px00030112391","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHORIONIC GONADOTROPIN QUANT","code_information":[{"code":"Px00030112393","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE","code_information":[{"code":"Px00030112394","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE GESTATIONAL SCREEN","code_information":[{"code":"Px00030112396","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOL GESTATIONAL","code_information":[{"code":"Px00030112397","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":87.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CEA","code_information":[{"code":"Px00030112404","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHOLESTEROL BODY FLUID","code_information":[{"code":"Px00030112407","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CO-OXIMETER PANEL VENOUS","code_information":[{"code":"Px00030112408","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL BODY FLUID LAB","code_information":[{"code":"Px00030112410","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL CSF","code_information":[{"code":"Px00030112411","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALK PHOS BONE SPECIFIC (ARUP)","code_information":[{"code":"Px00030112413","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS QNT PLASMA (ARUP)","code_information":[{"code":"Px00030112414","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN CONV ENZ CSF (ARUP)","code_information":[{"code":"Px00030112416","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL - REFLEX","code_information":[{"code":"Px00030112431","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM (RBC) (ARUP)","code_information":[{"code":"Px00030112432","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS TOTAL QUANT URINE LAB","code_information":[{"code":"Px00030112435","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":125.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PCP CONFIRM QUANT (ARUP)","code_information":[{"code":"Px00030112436","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PREGNENOLONE LCMS (ARUP)","code_information":[{"code":"Px00030112439","type":"CDM"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TSH RECEPTOR AB (ARUP)","code_information":[{"code":"Px00030112441","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B1 WHOLE BLOOD (ARUP)","code_information":[{"code":"Px00030112443","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030112474","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED - POST FILTER","code_information":[{"code":"Px00030112490","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPECIMENS)","code_information":[{"code":"Px00030112505","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":87.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY QUAL/SEMIQUAN GLUTAMIC ACID DECARBOXY AB LAB","code_information":[{"code":"Px00030112590","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030112591","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030112612","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE LAB","code_information":[{"code":"Px00030112630","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TSH","code_information":[{"code":"Px00030112660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN BODY FLUID","code_information":[{"code":"Px00030112662","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPEC)","code_information":[{"code":"Px00030112719","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":87.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C LAB","code_information":[{"code":"Px00030112722","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MYELIN-ASSOC GLYCOPROT AB IGM LAB","code_information":[{"code":"Px00030112749","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ACETYL RECEPT BLOCKING AB","code_information":[{"code":"Px00030112801","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES CDM","code_information":[{"code":"Px00030112845","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARSENIC (BLOOD)","code_information":[{"code":"Px00030112918","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY UREA NITROGEN","code_information":[{"code":"Px00030112990","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY ZINC","code_information":[{"code":"Px00030112994","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BETA-HYDROXYBUTRIC ACID","code_information":[{"code":"Px00030113017","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN CARBON MONO","code_information":[{"code":"Px00030113083","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C-TELOPEPTIDE CROSSLINK (CTXAR)","code_information":[{"code":"Px00030113181","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSS LINKS ANY METHOD LAB","code_information":[{"code":"Px00030113182","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GESTATIONAL GLUCOSE 1 HOUR","code_information":[{"code":"Px00030113354","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON CDM","code_information":[{"code":"Px00030113527","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATE(LD)(LDH)ENZYME","code_information":[{"code":"Px00030113542","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC METHYLMALONIC SERUM","code_information":[{"code":"Px00030113634","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030113810","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY IGF BINDING PROTEIN-3 LAB","code_information":[{"code":"Px00030113987","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES CDM","code_information":[{"code":"Px00030114059","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TSH REFLEX TO FT4","code_information":[{"code":"Px00030114208","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ASCORBIC ACID BLOOD CDM","code_information":[{"code":"Px00030114256","type":"CDM"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ASCORBIC ACID BLOOD","code_information":[{"code":"Px00030114257","type":"CDM"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB","code_information":[{"code":"Px00030114260","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE RANDOM","code_information":[{"code":"Px00030114273","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICROALBUMIN URINE RANDOM","code_information":[{"code":"Px00030114274","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE RANDOM","code_information":[{"code":"Px00030114278","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE RANDOM","code_information":[{"code":"Px00030114279","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE RANDOM","code_information":[{"code":"Px00030114280","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE RANDOM","code_information":[{"code":"Px00030114283","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SODIUM URINE RANDOM","code_information":[{"code":"Px00030114284","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN URINE RANDOM","code_information":[{"code":"Px00030114285","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE","code_information":[{"code":"Px00030114333","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN AMPHETAMINES","code_information":[{"code":"Px00030114373","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES","code_information":[{"code":"Px00030114374","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114384","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114387","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030200032","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200033","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200108","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200110","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200117","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A","code_information":[{"code":"Px00030200120","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA LAB","code_information":[{"code":"Px00030200128","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030200129","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200130","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200134","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200136","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB","code_information":[{"code":"Px00030200149","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST LAB","code_information":[{"code":"Px00030200184","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA LAB","code_information":[{"code":"Px00030200251","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200280","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200284","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200289","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MITOCHONDRIAL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200299","type":"CDM"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200414","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200415","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200430","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00030200431","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00030200432","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200491","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200533","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200534","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200560","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200571","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200572","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200633","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200634","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030200642","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT LAB","code_information":[{"code":"Px00030200663","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200664","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH","code_information":[{"code":"Px00030200665","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE","code_information":[{"code":"Px00030200697","type":"CDM"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH","code_information":[{"code":"Px00030200700","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL LAB","code_information":[{"code":"Px00030200811","type":"CDM"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.85,"discounted_cash":242.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL LAB","code_information":[{"code":"Px00030200812","type":"CDM"},{"code":"86833","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.74,"discounted_cash":243.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200817","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ACTIN SMOOTH MUSCLE ANTIBODY EACH LAB","code_information":[{"code":"Px00030200882","type":"CDM"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200899","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200990","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200991","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200992","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200993","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS DONOR HTLV I OR II LAB","code_information":[{"code":"Px00030201021","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030201022","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030210074","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ELECTROPHORESIS URINE","code_information":[{"code":"Px00030210084","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ADIPONECTIN(ARUP)","code_information":[{"code":"Px00030210088","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTRADIOL BY TMS(ARUP)","code_information":[{"code":"Px00030210089","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEPTIN(ARUP)","code_information":[{"code":"Px00030210091","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MAG AB IGM ELISA (ARUP)","code_information":[{"code":"Px00030210092","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGM","code_information":[{"code":"Px00030210101","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030210104","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGG","code_information":[{"code":"Px00030210105","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030210127","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030210170","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FACTOR V LEIDEN PCR","code_information":[{"code":"Px00030210180","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210251","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210254","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210255","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE","code_information":[{"code":"Px00030210302","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSA (RO) QUANTITATIVE","code_information":[{"code":"Px00030210311","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSB (LA) QUANTITATIVE","code_information":[{"code":"Px00030210312","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTISTREPTOLYSIN O QUANTITATIVE","code_information":[{"code":"Px00030210313","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARC ANTIBODY IDENT PANEL","code_information":[{"code":"Px00030210316","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARC ANTIGEN SCREEN-ANTIGEN","code_information":[{"code":"Px00030210318","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN","code_information":[{"code":"Px00030210319","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS GLACTO AG EIA(ARUP)","code_information":[{"code":"Px00030210337","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLATELET ANTIBODIES - HEPARIN","code_information":[{"code":"Px00030210346","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":76.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HSV 2 ANTIBODY IGG","code_information":[{"code":"Px00030210349","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MYCOPLSM CDM","code_information":[{"code":"Px00030210350","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030210360","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANA SCREEN QUANTITATIVE","code_information":[{"code":"Px00030210367","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANA SCREEN BODY FLUID","code_information":[{"code":"Px00030210370","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANA REFLEXIVE QUANTITATIVE","code_information":[{"code":"Px00030210371","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN","code_information":[{"code":"Px00030210399","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MUMPS ANTIBODY IGG","code_information":[{"code":"Px00030210401","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY","code_information":[{"code":"Px00030210405","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT TOTAL HEMOLYTIC CDM","code_information":[{"code":"Px00030210418","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C4","code_information":[{"code":"Px00030210421","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COLD AGGLUTININ TITER CDM","code_information":[{"code":"Px00030210424","type":"CDM"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C3","code_information":[{"code":"Px00030210426","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030210428","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY ANTI-RNP-SMITH LAB","code_information":[{"code":"Px00030210431","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTI-DNA QUANTITATIVE","code_information":[{"code":"Px00030210432","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN2 - COMPLIMENT ANTIGEN II","code_information":[{"code":"Px00030210462","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 IGG LAB","code_information":[{"code":"Px00030210466","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210500","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210501","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTI-ENA (SMITH) ANTIBODY","code_information":[{"code":"Px00030210521","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX TEST - TYPE 1 IGG","code_information":[{"code":"Px00030210524","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA IGG LAB","code_information":[{"code":"Px00030210525","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE AG AB","code_information":[{"code":"Px00030210532","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00030210533","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HETEROPHILE ANTIBODIES","code_information":[{"code":"Px00030210538","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN TETANUS CDM","code_information":[{"code":"Px00030210544","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TETANUS AB IGG(ARUP)","code_information":[{"code":"Px00030210546","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS","code_information":[{"code":"Px00030210547","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DIPTHERIA AND TETANUS AB (ARUP)","code_information":[{"code":"Px00030210551","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS LAB","code_information":[{"code":"Px00030210552","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT AB QUAN HEP B CDM","code_information":[{"code":"Px00030210564","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR","code_information":[{"code":"Px00030210590","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM","code_information":[{"code":"Px00030210598","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL","code_information":[{"code":"Px00030210605","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RPR TITER REFLEX","code_information":[{"code":"Px00030210610","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030210636","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA IGM ANTIBODY - PNEUMONIAE IGM","code_information":[{"code":"Px00030210646","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HIV-1","code_information":[{"code":"Px00030210715","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RAPID HIV 1-2","code_information":[{"code":"Px00030210718","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HIV-1/HIV-2 SINGLE ASSAY","code_information":[{"code":"Px00030210719","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEP B CORE (IGG-IGM) ANTIBODY","code_information":[{"code":"Px00030210728","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB CDM","code_information":[{"code":"Px00030210735","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB CDM","code_information":[{"code":"Px00030210737","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MUMPS VIRUS AB IGM (ARUP)","code_information":[{"code":"Px00030210740","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210747","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RUBELLA ANTIBODY","code_information":[{"code":"Px00030210766","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RUBELLA ANTIBODY (OF PANEL)","code_information":[{"code":"Px00030210771","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030210798","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH(D)","code_information":[{"code":"Px00030210861","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARC RH PHENOTYPE","code_information":[{"code":"Px00030210863","type":"CDM"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE LAB","code_information":[{"code":"Px00030210867","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":189.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO","code_information":[{"code":"Px00030210907","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIGEN TYPING-UNIT","code_information":[{"code":"Px00030210908","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIGEN TYPING-PATIENT","code_information":[{"code":"Px00030210909","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ELUTION","code_information":[{"code":"Px00030210912","type":"CDM"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210916","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC JO-1 AB IGG (ARUP)","code_information":[{"code":"Px00030210931","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MONO TEST","code_information":[{"code":"Px00030210933","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - CSF","code_information":[{"code":"Px00030210935","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM","code_information":[{"code":"Px00030210943","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB","code_information":[{"code":"Px00030210944","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA AMPLIFICATION APTIMA","code_information":[{"code":"Px00030210968","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030210971","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTOMEGALOVIRUS QUANT PCR(ARUP)","code_information":[{"code":"Px00030210994","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DETECT AGENT NOS-DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030210995","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211005","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS B VIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030211009","type":"CDM"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEP B SRF AG RFLX CNFRM(OF PANL)","code_information":[{"code":"Px00030211010","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEP B SURF AG (HBSAG) RFLX CONFRM","code_information":[{"code":"Px00030211011","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEP C PCR (QUAL)","code_information":[{"code":"Px00030211012","type":"CDM"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEP C PCR (QUANT)","code_information":[{"code":"Px00030211013","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C GENOTYPING","code_information":[{"code":"Px00030211015","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":613.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX PCR","code_information":[{"code":"Px00030211017","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HIV-1 RNA QUANTITATION","code_information":[{"code":"Px00030211022","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HSV PCR SOURCE OTHER","code_information":[{"code":"Px00030211028","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HSV PCR TYPING","code_information":[{"code":"Px00030211029","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIUM TB AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211036","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A SCREEN","code_information":[{"code":"Px00030211038","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA B SCREEN","code_information":[{"code":"Px00030211041","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":21.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRSA PCR","code_information":[{"code":"Px00030211050","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA PCR","code_information":[{"code":"Px00030211052","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211053","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211054","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA PNEUMOCYSTIS JIROVECI AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211056","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA INFLUENZA RSV AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211059","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA S AUREUS AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211062","type":"CDM"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXATION SERUM","code_information":[{"code":"Px00030211078","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":149.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"Px00030211079","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":149.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER","code_information":[{"code":"Px00030211088","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE LAB","code_information":[{"code":"Px00030211093","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE","code_information":[{"code":"Px00030211094","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RH (D)","code_information":[{"code":"Px00030211143","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CROSSMATCH 1 UNIT","code_information":[{"code":"Px00030211144","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":189.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ABO GROUP","code_information":[{"code":"Px00030211152","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":457.0,"discounted_cash":342.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RPR QUANTITATIVE","code_information":[{"code":"Px00030211505","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A-B PCR","code_information":[{"code":"Px00030211511","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":311.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C DIFFICILE TOXIN","code_information":[{"code":"Px00030310165","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500004","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500005","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030500006","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030500007","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500008","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500136","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500141","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED LAB","code_information":[{"code":"Px00030500147","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500148","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500155","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500169","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500190","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500214","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED LAB","code_information":[{"code":"Px00030500217","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500243","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500244","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"Px00030510023","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"Px00030510024","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB","code_information":[{"code":"Px00030510029","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED PLATELET COUNT","code_information":[{"code":"Px00030510030","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030510032","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL","code_information":[{"code":"Px00030510033","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VISCOSITY CDM","code_information":[{"code":"Px00030510035","type":"CDM"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FETAL","code_information":[{"code":"Px00030510036","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED RETICULOCYTE COUNT","code_information":[{"code":"Px00030510037","type":"CDM"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"Px00030510038","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY LAB","code_information":[{"code":"Px00030510039","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510049","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME","code_information":[{"code":"Px00030510050","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLETE CBC AUTOMATED","code_information":[{"code":"Px00030510062","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510063","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL 50-50","code_information":[{"code":"Px00030510067","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT INHIBITOR","code_information":[{"code":"Px00030510068","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DEGRADATION QUANT","code_information":[{"code":"Px00030510069","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RBC SED RATE AUTOMATED","code_information":[{"code":"Px00030510076","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED RBC COUNT","code_information":[{"code":"Px00030510077","type":"CDM"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY CDM","code_information":[{"code":"Px00030510084","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RISTOCETIN COFACTOR","code_information":[{"code":"Px00030510091","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EOSINOPHIL COUNT WHOLE BLOOD","code_information":[{"code":"Px00030510116","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY LMWH","code_information":[{"code":"Px00030510118","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COMPLETE CBC W/AUTO DIF WBC","code_information":[{"code":"Px00030510131","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC WBC COUNT ONLY","code_information":[{"code":"Px00030510148","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC WBC AUTO","code_information":[{"code":"Px00030510310","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030510327","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SEDIMENTATION RATE RBC AUTOMATED LAB","code_information":[{"code":"Px00030510399","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELL CNT-DIFF BF","code_information":[{"code":"Px00030510404","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELL CNT-DIFF CSF","code_information":[{"code":"Px00030510405","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELL CNT-DIFF SYNOVIAL","code_information":[{"code":"Px00030510406","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT ONLY","code_information":[{"code":"Px00030510407","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ANALYSIS BODY FLUID","code_information":[{"code":"Px00030510408","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030510415","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CD4","code_information":[{"code":"Px00030510419","type":"CDM"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030510426","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CORONAVIRUS AG IA LAB","code_information":[{"code":"Px00030600007","type":"CDM"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600012","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES LAB","code_information":[{"code":"Px00030600016","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600027","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB LAB","code_information":[{"code":"Px00030600103","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":175.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600113","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600115","type":"CDM"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO TRICHOMONAS VAGINALIS","code_information":[{"code":"Px00030600233","type":"CDM"},{"code":"87808","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB LAB","code_information":[{"code":"Px00030600318","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600380","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600400","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600413","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600415","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600447","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS LAB","code_information":[{"code":"Px00030600518","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030600519","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030600525","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600562","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","code_information":[{"code":"Px00030600564","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600567","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID LAB","code_information":[{"code":"Px00030600569","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":256.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID LAB","code_information":[{"code":"Px00030600570","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600571","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600573","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":125.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600574","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600575","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600576","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600578","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":63.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL LAB","code_information":[{"code":"Px00030600579","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","code_information":[{"code":"Px00030600580","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":144.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD LAB","code_information":[{"code":"Px00030600581","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":144.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL LAB","code_information":[{"code":"Px00030600583","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600612","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600613","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600614","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ LAB","code_information":[{"code":"Px00030600615","type":"CDM"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600619","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET","code_information":[{"code":"Px00030600672","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":848.0,"discounted_cash":636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600711","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600712","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030600784","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030600785","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030600786","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID CDM","code_information":[{"code":"Px00030600787","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL","code_information":[{"code":"Px00030600788","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","code_information":[{"code":"Px00030600789","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","code_information":[{"code":"Px00030600790","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA S AUREUS AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030600807","type":"CDM"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ CDM","code_information":[{"code":"Px00030600808","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES EXAM","code_information":[{"code":"Px00030610133","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC STREP GROUP A AG RFLX CULTURE","code_information":[{"code":"Px00030610149","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TRICHROME STAIN","code_information":[{"code":"Px00030610151","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PBP2 SCREEN","code_information":[{"code":"Px00030610153","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANAEROBIC DEFINITIVE ID","code_information":[{"code":"Px00030610155","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GNI (GRAM NEG ID)","code_information":[{"code":"Px00030610157","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610159","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GPI (GRAM POS ID)","code_information":[{"code":"Px00030610164","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA WEST NILE VIRUS AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030610167","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE TRANSFUSION REACT UNIT","code_information":[{"code":"Px00030610176","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-EAR","code_information":[{"code":"Px00030610177","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM","code_information":[{"code":"Px00030610178","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS LAB","code_information":[{"code":"Px00030610189","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610191","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610207","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COVID-19 AMP PRB HIGH THROUGHPUT PHS OREGON","code_information":[{"code":"Px00030610252","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-EYE SURFACE","code_information":[{"code":"Px00030610325","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-GENITAL-FEMALE","code_information":[{"code":"Px00030610329","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-RESPIR UPPER","code_information":[{"code":"Px00030610331","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-WOUND-SURFACE","code_information":[{"code":"Px00030610333","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-WOUND-DEEP","code_information":[{"code":"Px00030610334","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-SURGICAL TISSUE","code_information":[{"code":"Px00030610337","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL CDM","code_information":[{"code":"Px00030610366","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AEROBIC DEFINITIVE ID","code_information":[{"code":"Px00030610371","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-YEAST","code_information":[{"code":"Px00030610422","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":144.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC YBC (YEAST BIOCHEM)","code_information":[{"code":"Px00030610438","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZATION","code_information":[{"code":"Px00030610472","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PINWORM EXAMINATION CDM","code_information":[{"code":"Px00030610477","type":"CDM"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":38.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610482","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY-DISK 2","code_information":[{"code":"Px00030610492","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030610507","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SMEAR GRAM STAIN","code_information":[{"code":"Px00030610563","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GRAM STAIN","code_information":[{"code":"Px00030610566","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TISSUE EXAM FOR FUNGI - HAIR/NAIL/SKIN","code_information":[{"code":"Px00030610576","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GIARDIA ANTIGEN","code_information":[{"code":"Px00030610583","type":"CDM"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN CONC","code_information":[{"code":"Px00030610599","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-ANAEROBE","code_information":[{"code":"Px00030610600","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":256.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL AB IGG","code_information":[{"code":"Px00030610601","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-BLOOD","code_information":[{"code":"Px00030610604","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-RESPIR LOWER","code_information":[{"code":"Px00030610608","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-IV CATH TIP","code_information":[{"code":"Px00030610609","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-BODY FLUID","code_information":[{"code":"Px00030610610","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-CSF","code_information":[{"code":"Px00030610611","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC H PYLORI UREASE TEST","code_information":[{"code":"Px00030610622","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ","code_information":[{"code":"Px00030610623","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-METH RESIST S AUREUS","code_information":[{"code":"Px00030610628","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COVID-19 AMP PRB PHS OREGON 87635","code_information":[{"code":"Px00030610631","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CULTURE-URINE","code_information":[{"code":"Px00030610634","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":63.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE-HAIR NAIL SKIN","code_information":[{"code":"Px00030610637","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE-OTHER","code_information":[{"code":"Px00030610638","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":144.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE BLOOD","code_information":[{"code":"Px00030610639","type":"CDM"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC AFB CULTURE","code_information":[{"code":"Px00030610647","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOLOGIC ID","code_information":[{"code":"Px00030610648","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY-E TEST","code_information":[{"code":"Px00030610649","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY-DISK 1","code_information":[{"code":"Px00030610650","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY - MIC","code_information":[{"code":"Px00030610651","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HPYLORI STOOL CDM","code_information":[{"code":"Px00030610663","type":"CDM"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALCOFLUOR STAIN","code_information":[{"code":"Px00030610672","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN","code_information":[{"code":"Px00030610682","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI","code_information":[{"code":"Px00030610701","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700014","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":23.0,"discounted_cash":17.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700015","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700016","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700017","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":23.0,"discounted_cash":17.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00030710008","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":23.0,"discounted_cash":17.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM","code_information":[{"code":"Px00030710009","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICROSCOPIC EXAM OF URINE","code_information":[{"code":"Px00030710010","type":"CDM"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FAT/LIPIDS FECES QUALITATIVE CDM","code_information":[{"code":"Px00030710011","type":"CDM"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SEMEN ALYS MOTILITY&CNT X W/HUHNER TST CDM","code_information":[{"code":"Px00030710107","type":"CDM"},{"code":"89310","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00030900034","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030900035","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","code_information":[{"code":"Px00030900036","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS","code_information":[{"code":"Px00030900037","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00030900038","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS","code_information":[{"code":"Px00030900039","type":"CDM"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS","code_information":[{"code":"Px00030900040","type":"CDM"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.0,"discounted_cash":1884.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00030900041","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":282.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00030900042","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00030900043","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030900044","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS LAB","code_information":[{"code":"Px00030900045","type":"CDM"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.0,"discounted_cash":1884.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CEBPA GENE ANALYSIS FULL GENE SEQUENCE LAB","code_information":[{"code":"Px00030900046","type":"CDM"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS LAB","code_information":[{"code":"Px00030900047","type":"CDM"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS LAB","code_information":[{"code":"Px00030900048","type":"CDM"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS LAB","code_information":[{"code":"Px00030900049","type":"CDM"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":332.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00030900050","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030900051","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SO/HEMATOLYMPHOID NEO/DO 51/>GSAP DNA/DNA&RNA LAB","code_information":[{"code":"Px00030900052","type":"CDM"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":3795.0,"discounted_cash":2846.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SO/HEMATOLYMPHOID NEO/DO 51/>GSAP DNA/DNA&RNA LAB","code_information":[{"code":"Px00030900053","type":"CDM"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":2990.0,"discounted_cash":2242.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT","code_information":[{"code":"Px00030900054","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS","code_information":[{"code":"Px00030900055","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9","code_information":[{"code":"Px00030900056","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS","code_information":[{"code":"Px00030900057","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 LAB","code_information":[{"code":"Px00030900058","type":"CDM"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IDH1 COMMON VARIANTS LAB","code_information":[{"code":"Px00030900059","type":"CDM"},{"code":"81120","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":416.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IDH2 COMMON VARIANTS CDM","code_information":[{"code":"Px00030900060","type":"CDM"},{"code":"81121","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00030900061","type":"CDM"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 LAB","code_information":[{"code":"Px00030900062","type":"CDM"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS LAB","code_information":[{"code":"Px00030900063","type":"CDM"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT CDM","code_information":[{"code":"Px00030900064","type":"CDM"},{"code":"81305","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00030900065","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00030900066","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 LAB","code_information":[{"code":"Px00030900067","type":"CDM"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00030900068","type":"CDM"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS LAB","code_information":[{"code":"Px00030900069","type":"CDM"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB LAB","code_information":[{"code":"Px00031000032","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.0,"discounted_cash":1049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOMIC NEOPLASIA MICROARRAY ANALYSIS LAB","code_information":[{"code":"Px00031000052","type":"CDM"},{"code":"81277","type":"HCPCS"}],"standard_charges":[{"gross_charge":4640.0,"discounted_cash":3480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA LAB","code_information":[{"code":"Px00031000061","type":"CDM"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":834.0,"discounted_cash":625.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE LAB","code_information":[{"code":"Px00031000082","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE","code_information":[{"code":"Px00031000083","type":"CDM"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ELECTRON MICROSCOPY DIAGNOSTIC LAB","code_information":[{"code":"Px00031000146","type":"CDM"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH","code_information":[{"code":"Px00031000150","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":625.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR LAB","code_information":[{"code":"Px00031000152","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR","code_information":[{"code":"Px00031000231","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":625.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000287","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000288","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000289","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000290","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000291","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000292","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000293","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000294","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000295","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000296","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000297","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000324","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000325","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&DQB CDM","code_information":[{"code":"Px00031000469","type":"CDM"},{"code":"81370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":1146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA CDM","code_information":[{"code":"Px00031000470","type":"CDM"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA CDM","code_information":[{"code":"Px00031010138","type":"CDM"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":261.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TPMT GENE ANALAYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031010165","type":"CDM"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PATHOGEN TEST FOR PLATELETS","code_information":[{"code":"Px00031010176","type":"CDM"},{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH LAB","code_information":[{"code":"Px00031010182","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":625.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","code_information":[{"code":"Px00031010216","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":217.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG HER2NEU BY FISH","code_information":[{"code":"Px00031010217","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","code_information":[{"code":"Px00031010219","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 1","code_information":[{"code":"Px00031010232","type":"CDM"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 2","code_information":[{"code":"Px00031010233","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 3","code_information":[{"code":"Px00031010234","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 4","code_information":[{"code":"Px00031010235","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 5","code_information":[{"code":"Px00031010236","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 6","code_information":[{"code":"Px00031010237","type":"CDM"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.0,"discounted_cash":765.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG SPECIAL STAINS GROUP 1","code_information":[{"code":"Px00031010239","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":212.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL SURG SPECIAL STAINS GROUP 2","code_information":[{"code":"Px00031010240","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS 20-25 CELLS LAB","code_information":[{"code":"Px00031010286","type":"CDM"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ LAB","code_information":[{"code":"Px00031010312","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTO SPIN","code_information":[{"code":"Px00031010314","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":214.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":243.0,"discounted_cash":182.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH SMEAR OTHER SOURCE PREP/SCREEN","code_information":[{"code":"Px00031010337","type":"CDM"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATION SMEARS & INTERPRETATION TECH LAB","code_information":[{"code":"Px00031010339","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DECALCIFICATION PROCEDURE LAB","code_information":[{"code":"Px00031010341","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS LAB","code_information":[{"code":"Px00031010351","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":355.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPJ 2-8 MARKERS LAB","code_information":[{"code":"Px00031010365","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":290.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":359.0,"discounted_cash":269.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031010386","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":406.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1584.0,"discounted_cash":1188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN LAB","code_information":[{"code":"Px00031010406","type":"CDM"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL LAB","code_information":[{"code":"Px00031010407","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION LAB","code_information":[{"code":"Px00031010468","type":"CDM"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PATHOLOGY CONSULTATION DURING SURGERY LAB","code_information":[{"code":"Px00031010476","type":"CDM"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST CDM","code_information":[{"code":"Px00031010481","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB","code_information":[{"code":"Px00031010498","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":212.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT LAB","code_information":[{"code":"Px00031010500","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB","code_information":[{"code":"Px00031010519","type":"CDM"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010520","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010522","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010524","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010531","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010536","type":"CDM"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.0,"discounted_cash":765.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST LAB","code_information":[{"code":"Px00031010565","type":"CDM"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":340.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL LAB","code_information":[{"code":"Px00031010566","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":217.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":103.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS LAB","code_information":[{"code":"Px00031010599","type":"CDM"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLL IGVH MUTATION","code_information":[{"code":"Px00031010612","type":"CDM"},{"code":"81260","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH LAB","code_information":[{"code":"Px00031010671","type":"CDM"},{"code":"88369","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":333.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1399.0,"discounted_cash":1049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":438.0,"discounted_cash":328.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SO/HEMATOLYMPHOID NEO/DO GTE 51 GSAP DNA/DNA&RNA LAB","code_information":[{"code":"Px00031010709","type":"CDM"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":5060.0,"discounted_cash":3795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN LAB","code_information":[{"code":"Px00031010842","type":"CDM"},{"code":"88366","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":249.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH","code_information":[{"code":"Px00031010848","type":"CDM"},{"code":"81373","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":261.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPJ 2-8 MARKERS","code_information":[{"code":"Px00031100047","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":313.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL CYTO FNA INTERP","code_information":[{"code":"Px00031110004","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":182.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL CYTO NON GYN CONC SMR-INT","code_information":[{"code":"Px00031110005","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BILL CYTO NON GYN LBC-INT","code_information":[{"code":"Px00031110006","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PAP SUREPATH DIAGNOSTIC","code_information":[{"code":"Px00031110030","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN CDM","code_information":[{"code":"Px00031110031","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE OTHER SOURCE (RL)","code_information":[{"code":"Px00031900015","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-1 CDM","code_information":[{"code":"Px00031900032","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-2 CDM","code_information":[{"code":"Px00031900033","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00031900057","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS (RL)","code_information":[{"code":"Px00031900059","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA CDM","code_information":[{"code":"Px00031900089","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00031900112","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI(RL)","code_information":[{"code":"Px00031900180","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC CDM","code_information":[{"code":"Px00031900237","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00031900238","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR EYE FOR FOREIGN BODY","code_information":[{"code":"Px00032010003","type":"CDM"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010004","type":"CDM"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"Px00032010007","type":"CDM"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":335.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES LT/3 VIEWS","code_information":[{"code":"Px00032010011","type":"CDM"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010012","type":"CDM"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR NASAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010014","type":"CDM"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":252.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SINUSES PARANASAL MIN 3 VIEWS","code_information":[{"code":"Px00032010020","type":"CDM"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"Px00032010022","type":"CDM"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR JAW TEMPOROMANDIBULAR JOINT BIL","code_information":[{"code":"Px00032010028","type":"CDM"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"Px00032010029","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"Px00032010031","type":"CDM"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR BONE LENGTH STUDY","code_information":[{"code":"Px00032010039","type":"CDM"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ESOPHAGUS W CONTRAST","code_information":[{"code":"Px00032010041","type":"CDM"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR RIBS UNI 2 VIEWS","code_information":[{"code":"Px00032010045","type":"CDM"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST UNI MIN 3 VIEWS","code_information":[{"code":"Px00032010046","type":"CDM"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":342.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR RIBS BIL 3 VIEWS","code_information":[{"code":"Px00032010048","type":"CDM"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":259.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST BILAT","code_information":[{"code":"Px00032010049","type":"CDM"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM MIN 2 VIEWS","code_information":[{"code":"Px00032010050","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR STERNOCLAVICULAR JOINTS MIN 3 VIEWS","code_information":[{"code":"Px00032010051","type":"CDM"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE 1 VIEW ANY LEVEL","code_information":[{"code":"Px00032010053","type":"CDM"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":198.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010055","type":"CDM"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"Px00032010056","type":"CDM"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":383.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR CERVICAL SPINE 6 OR MORE VIEWS","code_information":[{"code":"Px00032010057","type":"CDM"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"Px00032010059","type":"CDM"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":276.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"Px00032010060","type":"CDM"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC MIN 4 VIEWS","code_information":[{"code":"Px00032010061","type":"CDM"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACOLUMBAR MIN 2 VIEWS","code_information":[{"code":"Px00032010062","type":"CDM"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":276.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010065","type":"CDM"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPINE LUMBOSACRAL MIN 4 VIEWS","code_information":[{"code":"Px00032010066","type":"CDM"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":261.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL INC BENDING MIN 6 VIEWS","code_information":[{"code":"Px00032010067","type":"CDM"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SPINE 2-3 VIEWS LUMBAR BEND ONLY","code_information":[{"code":"Px00032010068","type":"CDM"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS 1-2 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010069","type":"CDM"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS MIN 3 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010072","type":"CDM"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 1-2 VIEWS","code_information":[{"code":"Px00032010073","type":"CDM"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 3/PLUS VIEWS","code_information":[{"code":"Px00032010074","type":"CDM"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":312.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR TAILBONE MIN 2 VIEWS","code_information":[{"code":"Px00032010075","type":"CDM"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR CLAVICLE  COMPLETE","code_information":[{"code":"Px00032010085","type":"CDM"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW LIMITED","code_information":[{"code":"Px00032010086","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":218.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR HEEL MIN 2 VIEWS","code_information":[{"code":"Px00032010088","type":"CDM"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":205.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"Px00032010089","type":"CDM"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":255.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"Px00032010091","type":"CDM"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":245.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER 1 VIEW","code_information":[{"code":"Px00032010092","type":"CDM"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER A-C JOINTS BIL","code_information":[{"code":"Px00032010099","type":"CDM"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":275.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS 1 VIEW","code_information":[{"code":"Px00032010101","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"Px00032010102","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"Px00032010105","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":218.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010106","type":"CDM"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"Px00032010107","type":"CDM"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"Px00032010110","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":190.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"Px00032010112","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ARM INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010115","type":"CDM"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 1 VIEW","code_information":[{"code":"Px00032010117","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"Px00032010118","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR WRIST COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010119","type":"CDM"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":237.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR HAND 1 VIEW","code_information":[{"code":"Px00032010125","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"Px00032010127","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR HAND MIN 3 VIEWS","code_information":[{"code":"Px00032010129","type":"CDM"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":247.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FINGERS(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010131","type":"CDM"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 3/PLUS VIEWS","code_information":[{"code":"Px00032010135","type":"CDM"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 1-2 VIEWS","code_information":[{"code":"Px00032010149","type":"CDM"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"Px00032010152","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":275.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 4/PLUS VIEWS","code_information":[{"code":"Px00032010154","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":317.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR KNEES STANDING BILAT","code_information":[{"code":"Px00032010156","type":"CDM"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG 2 VIEWS","code_information":[{"code":"Px00032010159","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":229.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR LEG INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010161","type":"CDM"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":245.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"Px00032010163","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010165","type":"CDM"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN COMPLETE SERIES","code_information":[{"code":"Px00032010175","type":"CDM"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY","code_information":[{"code":"Px00032010179","type":"CDM"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":256.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":651.0,"discounted_cash":488.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":948.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN PORTABLE 1 VIEW","code_information":[{"code":"Px00032010190","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR COLON W CONTRAST","code_information":[{"code":"Px00032010191","type":"CDM"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR COLON DOUBLE CONTRAST","code_information":[{"code":"Px00032010192","type":"CDM"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":746.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00032010196","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.0,"discounted_cash":663.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR UROGRAPHY RETROGRADE W/WO KUB W CONTRAST","code_information":[{"code":"Px00032010211","type":"CDM"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":687.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR UTERUS & FALLOPIAN TUBE W CONTRAST","code_information":[{"code":"Px00032010223","type":"CDM"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":328.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"Px00032010318","type":"CDM"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":546.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR PEDIATRIC FOREIGN BODY 1 VIEW","code_information":[{"code":"Px00032010320","type":"CDM"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FISTULA/SINUS ABSCESS","code_information":[{"code":"Px00032010321","type":"CDM"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1314.0,"discounted_cash":985.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"Px00032010322","type":"CDM"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","code_information":[{"code":"Px00032010330","type":"CDM"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":251.0,"discounted_cash":188.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","code_information":[{"code":"Px00032010337","type":"CDM"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"Px00032010338","type":"CDM"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":252.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY COMPLETE","code_information":[{"code":"Px00032010341","type":"CDM"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":784.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY INFANT","code_information":[{"code":"Px00032010342","type":"CDM"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR JOINT SURVEY 1 VIEW","code_information":[{"code":"Px00032010343","type":"CDM"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR DXA BONE DENSITY STUDY AXIAL","code_information":[{"code":"Px00032010344","type":"CDM"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":342.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BONE DENSITY PERIPHERAL SKELETON","code_information":[{"code":"Px00032010345","type":"CDM"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY CDM","code_information":[{"code":"Px00032010351","type":"CDM"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":770.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER COMPLETE MIN 2 VIEWS","code_information":[{"code":"Px00032010481","type":"CDM"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":352.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 1 VIEW","code_information":[{"code":"Px00032010483","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 1 VIEW","code_information":[{"code":"Px00032010503","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 1 VIEW","code_information":[{"code":"Px00032010505","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":190.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DXA BONE DENSITY AXIAL WITH VFA","code_information":[{"code":"Px00032010602","type":"CDM"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":345.0,"discounted_cash":258.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED 2 VIEWS","code_information":[{"code":"Px00032010611","type":"CDM"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":258.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":345.0,"discounted_cash":258.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":658.0,"discounted_cash":493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR 1 VIEW","code_information":[{"code":"Px00032010614","type":"CDM"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR MIN 2 VIEWS","code_information":[{"code":"Px00032010615","type":"CDM"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"Px00032410014","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"Px00032410015","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":198.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 3 VIEWS","code_information":[{"code":"Px00032410016","type":"CDM"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC XR CHEST PORTABLE 1 VIEW","code_information":[{"code":"Px00032410018","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMO SQ OR IM NON HORMONAL CDM","code_information":[{"code":"Px00033110001","type":"CDM"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO CDM","code_information":[{"code":"Px00033110002","type":"CDM"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":524.0,"discounted_cash":393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":471.0,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00033510003","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":843.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION ADDL HR CDM","code_information":[{"code":"Px00033510004","type":"CDM"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":330.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION PROLONG VIA PORTABLE OR IMPLANTABLE PUMP > 8HRS CDM","code_information":[{"code":"Px00033510005","type":"CDM"},{"code":"96416","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":741.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":994.0,"discounted_cash":745.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMO IA INFUSE EACH ADDL HR CDM","code_information":[{"code":"Px00033510010","type":"CDM"},{"code":"96423","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TYSABRI INFUSION FIRST HR","code_information":[{"code":"Px00033510017","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":843.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMO INITIATE PORTAB PUMP FOR HOME USE INCL PUMP EQUIP & F/U VISIT CDM","code_information":[{"code":"Px00033510024","type":"CDM"},{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":687.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK WO CONTRAST","code_information":[{"code":"Px00035010007","type":"CDM"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.0,"discounted_cash":1509.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W CONTRAST","code_information":[{"code":"Px00035010008","type":"CDM"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2089.0,"discounted_cash":1566.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W & W/O CONTRAST","code_information":[{"code":"Px00035010009","type":"CDM"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":2243.0,"discounted_cash":1682.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY NECK W CONTRAST","code_information":[{"code":"Px00035010010","type":"CDM"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":2255.0,"discounted_cash":1691.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT THORAX WO CONTRAST","code_information":[{"code":"Px00035010011","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2562.0,"discounted_cash":1921.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY CHEST","code_information":[{"code":"Px00035010013","type":"CDM"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1883.0,"discounted_cash":1412.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT LWR EXTREMITY WO & W CONTRAST","code_information":[{"code":"Px00035010018","type":"CDM"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2545.0,"discounted_cash":1908.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO LWR EXTR W/O&W/DYE","code_information":[{"code":"Px00035010020","type":"CDM"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1931.0,"discounted_cash":1448.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035010023","type":"CDM"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":1826.0,"discounted_cash":1369.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ABD & PELVIS WO CONTRAST","code_information":[{"code":"Px00035010024","type":"CDM"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.0,"discounted_cash":1384.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W  CONTRAST","code_information":[{"code":"Px00035010025","type":"CDM"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":2529.0,"discounted_cash":1896.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST","code_information":[{"code":"Px00035010027","type":"CDM"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CTA AORTA BIL ILIOFEM W & W/O CONTRAST","code_information":[{"code":"Px00035010031","type":"CDM"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2209.0,"discounted_cash":1656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC 3D RENDERING W/POSTPROCESS","code_information":[{"code":"Px00035010033","type":"CDM"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":205.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN PELVIS","code_information":[{"code":"Px00035010072","type":"CDM"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":4348.0,"discounted_cash":3261.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN WO CONTRAST","code_information":[{"code":"Px00035110002","type":"CDM"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1039.0,"discounted_cash":779.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W CONTRAST","code_information":[{"code":"Px00035110007","type":"CDM"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":1622.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W & W/O CONTRAST","code_information":[{"code":"Px00035110012","type":"CDM"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":1878.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA WO CONTRAST","code_information":[{"code":"Px00035110014","type":"CDM"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":837.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W CONTRAST","code_information":[{"code":"Px00035110017","type":"CDM"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W & W/O CONTRAST","code_information":[{"code":"Px00035110019","type":"CDM"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2424.0,"discounted_cash":1818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL WO CONTRAST","code_information":[{"code":"Px00035110022","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.0,"discounted_cash":1536.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL W CONTRAST","code_information":[{"code":"Px00035110030","type":"CDM"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":1687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"Px00035110032","type":"CDM"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.0,"discounted_cash":1792.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":308.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W CONTRAST","code_information":[{"code":"Px00035210003","type":"CDM"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2655.0,"discounted_cash":1991.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W & W/O CONTRAST","code_information":[{"code":"Px00035210006","type":"CDM"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3310.0,"discounted_cash":2482.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE WO CONTRAST","code_information":[{"code":"Px00035210008","type":"CDM"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":2426.0,"discounted_cash":1819.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE W/DYE","code_information":[{"code":"Px00035210009","type":"CDM"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":2611.0,"discounted_cash":1958.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE WO CONTRAST","code_information":[{"code":"Px00035210011","type":"CDM"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2803.0,"discounted_cash":2102.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W CONTRAST","code_information":[{"code":"Px00035210012","type":"CDM"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":2924.0,"discounted_cash":2193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210013","type":"CDM"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":3070.0,"discounted_cash":2302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE WO CONTRAST","code_information":[{"code":"Px00035210014","type":"CDM"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":2008.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W CONTRAST","code_information":[{"code":"Px00035210015","type":"CDM"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2875.0,"discounted_cash":2156.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210016","type":"CDM"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":3070.0,"discounted_cash":2302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"Px00035210018","type":"CDM"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.0,"discounted_cash":896.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"Px00035210020","type":"CDM"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1275.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210029","type":"CDM"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2225.0,"discounted_cash":1668.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210030","type":"CDM"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2206.0,"discounted_cash":1654.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210031","type":"CDM"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2310.0,"discounted_cash":1732.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO UPR EXTRM W & W/O CONTRAST","code_information":[{"code":"Px00035210037","type":"CDM"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":1221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"Px00035210038","type":"CDM"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2414.0,"discounted_cash":1810.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210040","type":"CDM"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2349.0,"discounted_cash":1761.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"Px00035210046","type":"CDM"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":1878.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035210047","type":"CDM"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":3057.0,"discounted_cash":2292.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210054","type":"CDM"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":3322.0,"discounted_cash":2491.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":2562.0,"discounted_cash":1921.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RT BRONCH LEVEL 1 CDM","code_information":[{"code":"Px00036000021","type":"CDM"}],"standard_charges":[{"gross_charge":3912.0,"discounted_cash":2934.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 2 CDM","code_information":[{"code":"Px00036000022","type":"CDM"}],"standard_charges":[{"gross_charge":6796.0,"discounted_cash":5097.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 3 CDM","code_information":[{"code":"Px00036000023","type":"CDM"}],"standard_charges":[{"gross_charge":8234.0,"discounted_cash":6175.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 4 CDM","code_information":[{"code":"Px00036000024","type":"CDM"}],"standard_charges":[{"gross_charge":9927.0,"discounted_cash":7445.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 5 CDM","code_information":[{"code":"Px00036000025","type":"CDM"}],"standard_charges":[{"gross_charge":14412.0,"discounted_cash":10809.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 6 CDM","code_information":[{"code":"Px00036000026","type":"CDM"}],"standard_charges":[{"gross_charge":16366.0,"discounted_cash":12274.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"Px00036010107","type":"CDM"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":238.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF BREAST LESION","code_information":[{"code":"Px00036010111","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE","code_information":[{"code":"Px00036010131","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SHOULDER X-RAY","code_information":[{"code":"Px00036010133","type":"CDM"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":540.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 1ST 30 MINS","code_information":[{"code":"Px00036010146","type":"CDM"}],"standard_charges":[{"gross_charge":10243.0,"discounted_cash":7682.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 1ST 30 MINS","code_information":[{"code":"Px00036010147","type":"CDM"}],"standard_charges":[{"gross_charge":10755.0,"discounted_cash":8066.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 1ST 30 MINS","code_information":[{"code":"Px00036010148","type":"CDM"}],"standard_charges":[{"gross_charge":11293.0,"discounted_cash":8469.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 1ST 30 MINS","code_information":[{"code":"Px00036010149","type":"CDM"}],"standard_charges":[{"gross_charge":11858.0,"discounted_cash":8893.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 1ST 30 MINS","code_information":[{"code":"Px00036010150","type":"CDM"}],"standard_charges":[{"gross_charge":12451.0,"discounted_cash":9338.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 1ST 30 MINS","code_information":[{"code":"Px00036010151","type":"CDM"}],"standard_charges":[{"gross_charge":13073.0,"discounted_cash":9804.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS","code_information":[{"code":"Px00036010152","type":"CDM"}],"standard_charges":[{"gross_charge":13726.0,"discounted_cash":10294.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 1ST 30 MINS","code_information":[{"code":"Px00036010153","type":"CDM"}],"standard_charges":[{"gross_charge":14414.0,"discounted_cash":10810.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 PER MIN","code_information":[{"code":"Px00036010212","type":"CDM"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":37.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 PER MIN","code_information":[{"code":"Px00036010214","type":"CDM"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 PER MIN","code_information":[{"code":"Px00036010216","type":"CDM"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 PER MIN","code_information":[{"code":"Px00036010218","type":"CDM"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 PER MIN","code_information":[{"code":"Px00036010220","type":"CDM"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 PER MIN","code_information":[{"code":"Px00036010222","type":"CDM"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 PER MIN","code_information":[{"code":"Px00036010224","type":"CDM"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":101.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"Px00036010345","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASPIRATION AND/OR INJECTION THYROID CYST CDM","code_information":[{"code":"Px00036010350","type":"CDM"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2378.0,"discounted_cash":1783.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LASER YAG BILATERAL","code_information":[{"code":"Px00036010494","type":"CDM"}],"standard_charges":[{"gross_charge":3786.0,"discounted_cash":2839.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MINOR PROC CLASS III","code_information":[{"code":"Px00036010643","type":"CDM"}],"standard_charges":[{"gross_charge":2178.0,"discounted_cash":1633.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROC FIXED OPTH YAG 1 EYE","code_information":[{"code":"Px00036010879","type":"CDM"}],"standard_charges":[{"gross_charge":3114.0,"discounted_cash":2335.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C-SECTION","code_information":[{"code":"Px00036010960","type":"CDM"}],"standard_charges":[{"gross_charge":18122.0,"discounted_cash":13591.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1733.0,"discounted_cash":1299.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC C-SECTION MULTI","code_information":[{"code":"Px00036010966","type":"CDM"}],"standard_charges":[{"gross_charge":21748.0,"discounted_cash":16311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HIP ARTHROGRAM PROC","code_information":[{"code":"Px00036011002","type":"CDM"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LAPAROSCOPIC CHOLECYSTECTOMY","code_information":[{"code":"Px00036011107","type":"CDM"},{"code":"47562","type":"HCPCS"}],"standard_charges":[{"gross_charge":15806.0,"discounted_cash":11854.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1837.0,"discounted_cash":1377.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC CDM","code_information":[{"code":"Px00036100010","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1329.0,"discounted_cash":996.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INS NON INDWELLING BLADDER CATH / STRAIGHT CDM","code_information":[{"code":"Px00036100021","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1101.0,"discounted_cash":825.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NASAL/OROGASTRIC W/TUBE PLMT","code_information":[{"code":"Px00036110042","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"Px00036110071","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX","code_information":[{"code":"Px00036110110","type":"CDM"},{"code":"49424","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"Px00036110122","type":"CDM"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":149.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3321.0,"discounted_cash":2490.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL","code_information":[{"code":"Px00036110242","type":"CDM"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.0,"discounted_cash":1245.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NJX PX KNEE ARTHG OR CNTRST ENHNCD CT/MRI KNEE","code_information":[{"code":"Px00036110253","type":"CDM"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":885.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"Px00036110260","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6271.0,"discounted_cash":4703.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2444.0,"discounted_cash":1833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC WO IMG GDN GTE 5 YR","code_information":[{"code":"Px00036110432","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":2352.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4920.0,"discounted_cash":3690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INJ W/FLUOR EVAL CV DEVICE","code_information":[{"code":"Px00036110455","type":"CDM"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":151.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","code_information":[{"code":"Px00036110456","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":420.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00036110457","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":289.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC APPLICATION OF UNABOOT BIL","code_information":[{"code":"Px00036110555","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","code_information":[{"code":"Px00036110562","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":885.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":820.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INSERT EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00036110619","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":977.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00036110646","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036110662","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1077.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NON HOSP DELIVERY EPISIOTOMY/VAG REPAIR CDM","code_information":[{"code":"Px00036110737","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"Px00036110934","type":"CDM"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3502.0,"discounted_cash":2626.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":2352.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1901.0,"discounted_cash":1425.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1901.0,"discounted_cash":1425.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION STEREO","code_information":[{"code":"Px00036111183","type":"CDM"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":7000.0,"discounted_cash":5250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION STEREO","code_information":[{"code":"Px00036111184","type":"CDM"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":4806.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6250.0,"discounted_cash":4687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION US IMAG","code_information":[{"code":"Px00036111186","type":"CDM"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":5617.0,"discounted_cash":4212.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PERQ DEVICE LOC BREAST 1ST IMAG","code_information":[{"code":"Px00036111189","type":"CDM"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":822.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST 1ST US IMAG","code_information":[{"code":"Px00036111193","type":"CDM"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2245.0,"discounted_cash":1683.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1516.0,"discounted_cash":1137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1819.0,"discounted_cash":1364.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1092.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":689.0,"discounted_cash":516.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00036112004","type":"CDM"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":432.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EPIDURAL BLOOD PATCH","code_information":[{"code":"Px00036119030","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":2545.0,"discounted_cash":1908.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1648.0,"discounted_cash":1236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM CDM","code_information":[{"code":"Px00036136904","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VNPNXR 3 YEARS/> PHYS/QHP SKILL- MIDLINE CATHETER INSERTION > 3 YR","code_information":[{"code":"Px00036155555","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":821.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA IV GA 1ST HOUR CDM","code_information":[{"code":"Px00037010123","type":"CDM"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":1209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA IV GA 15 MIN CDM","code_information":[{"code":"Px00037010124","type":"CDM"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA MAC 1ST HOUR CDM","code_information":[{"code":"Px00037010125","type":"CDM"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":1209.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA MAC 15 MIN CTP CDM","code_information":[{"code":"Px00037010126","type":"CDM"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA REGIONAL 1ST HOUR CDM","code_information":[{"code":"Px00037010129","type":"CDM"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":479.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ANESTHESIA REGIONAL 15 MIN CDM","code_information":[{"code":"Px00037010130","type":"CDM"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":405.0,"discounted_cash":303.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":338.0,"discounted_cash":253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":167.0,"discounted_cash":125.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT","code_information":[{"code":"Px00039010002","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED","code_information":[{"code":"Px00039010015","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA EA UNIT FRZ W/IN 8 HR","code_information":[{"code":"Px00039010017","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCED","code_information":[{"code":"Px00039010031","type":"CDM"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":879.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDU IRRAD","code_information":[{"code":"Px00039010033","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1261.0,"discounted_cash":945.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLT PHERESIS HLA MATCHED LEUK REDUCED","code_information":[{"code":"Px00039010039","type":"CDM"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1621.0,"discounted_cash":1215.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA FRZ BETWEEN 8-24HOUR","code_information":[{"code":"Px00039010045","type":"CDM"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED","code_information":[{"code":"Px00039010055","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLATELETS PHERESIS PATH REDU","code_information":[{"code":"Px00039010064","type":"CDM"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":675.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLATELETS LEUKOREDUCED IRRAD","code_information":[{"code":"Px00039010102","type":"CDM"},{"code":"P9033","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":432.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD TRANSFUSION EA UNIT CDM","code_information":[{"code":"Px00039110001","type":"CDM"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":639.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED WASHED","code_information":[{"code":"Px00039910006","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG BIL W CAD","code_information":[{"code":"Px00040110004","type":"CDM"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":380.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG UNI W CAD","code_information":[{"code":"Px00040110005","type":"CDM"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":312.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SCREENING BREAST TOMOSYNTHESIS BI","code_information":[{"code":"Px00040110020","type":"CDM"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TOMOSYNTHESIS MAMMO UNI OR BIL DIAGNOSTIC","code_information":[{"code":"Px00040110021","type":"CDM"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY CDM","code_information":[{"code":"Px00040200005","type":"CDM"},{"code":"76883","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US EXAM CHEST","code_information":[{"code":"Px00040210005","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":542.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US EXAM ABDOMEN COMPLETE","code_information":[{"code":"Px00040210008","type":"CDM"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC LIMITED","code_information":[{"code":"Px00040210009","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":389.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL COMPLETE","code_information":[{"code":"Px00040210010","type":"CDM"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":522.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL LIMITED","code_information":[{"code":"Px00040210011","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":522.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US EXAM KIDNEY TRANSPLANT W/DOPPLER","code_information":[{"code":"Px00040210012","type":"CDM"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":573.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS SINGLE FETUS CDM","code_information":[{"code":"Px00040210014","type":"CDM"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":519.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS ADDL FETUS CDM","code_information":[{"code":"Px00040210015","type":"CDM"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":122.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":635.0,"discounted_cash":476.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US OB AFTER 1ST TRIMESTER ADD FETUS","code_information":[{"code":"Px00040210017","type":"CDM"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":128.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US OB FOLLOW-UP PER FETUS CDM","code_information":[{"code":"Px00040210023","type":"CDM"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":317.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US OB TRANSVAGINAL CDM","code_information":[{"code":"Px00040210024","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/NST CDM","code_information":[{"code":"Px00040210025","type":"CDM"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":609.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/O NST CDM","code_information":[{"code":"Px00040210026","type":"CDM"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":609.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00040210033","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":256.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US EXAM SCROTUM & CONTENTS","code_information":[{"code":"Px00040210036","type":"CDM"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":366.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US JOINT COMPLETE","code_information":[{"code":"Px00040210041","type":"CDM"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":332.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US INFANT HIPS DYNAMIC","code_information":[{"code":"Px00040210045","type":"CDM"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":381.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00040210049","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":517.0,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAMINATION PROCEDURE UNLISTED","code_information":[{"code":"Px00040210061","type":"CDM"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC POCUS US GUIDE FOR BIOPSY NEEDLE PLACEMENT","code_information":[{"code":"Px00040210062","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US UMBILICAL ARTERY ECHO CDM","code_information":[{"code":"Px00040210076","type":"CDM"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":200.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US PELVIC NON-OB COMPLETE","code_information":[{"code":"Px00040210093","type":"CDM"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":524.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US ABDOMEN LIMITED","code_information":[{"code":"Px00040210104","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":455.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI COMPLETE","code_information":[{"code":"Px00040210136","type":"CDM"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI LIMITED","code_information":[{"code":"Px00040210137","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US ABD AORTA SCRN AAA","code_information":[{"code":"Px00040210142","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":234.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN BIL W CAD","code_information":[{"code":"Px00040310004","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":353.0,"discounted_cash":264.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INTUBATION CDM","code_information":[{"code":"Px00041010003","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":977.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ARTERIAL CATHETER DRAW - ESTABLISHED - CDM","code_information":[{"code":"Px00041010005","type":"CDM"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW ARTERIAL PUNCTURE CDM","code_information":[{"code":"Px00041010006","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00041010007","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1489.0,"discounted_cash":1116.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PULMONARY MECHANICS (VITAL CAPACITY TOTAL -  SEPARATE PROCEDURE)","code_information":[{"code":"Px00041010008","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00041010012","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY OVERNIGHT STUDY CDM","code_information":[{"code":"Px00041010013","type":"CDM"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":633.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL CHEST WALL OSCILL CDM","code_information":[{"code":"Px00041010023","type":"CDM"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":211.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":394.0,"discounted_cash":295.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ CDM","code_information":[{"code":"Px00041010263","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION FIRST DAY CDM","code_information":[{"code":"Px00041010290","type":"CDM"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":1982.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010296","type":"CDM"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1919.0,"discounted_cash":1439.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP DAILY CDM","code_information":[{"code":"Px00041010325","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010328","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATION POSTURAL DRAINAGE 3 POSITIONS OR LESS","code_information":[{"code":"Px00041010338","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATPOSTURAL DRAINAGE GT/4 POSITIONS CDM","code_information":[{"code":"Px00041010341","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":203.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INHALATION TREATMENT DAILY","code_information":[{"code":"Px00041210006","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":289.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP CDM","code_information":[{"code":"Px00042000005","type":"CDM"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC REM THER MNTR DEV SPLY MUSCSKEL SYS EA 30D CDM","code_information":[{"code":"Px00042000007","type":"CDM"},{"code":"98977","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN","code_information":[{"code":"Px00042000050","type":"CDM"},{"code":"98980","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN","code_information":[{"code":"Px00042000051","type":"CDM"},{"code":"98981","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":379.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BFB TRAING W/EMG AND /MANOMETRY 1ST 15 MIN CNTCT CDM","code_information":[{"code":"Px00042010008","type":"CDM"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":394.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BFB TRAING W/EMG AND /MANOMETRY EA ADDL 15 MIN CNTCT CDM","code_information":[{"code":"Px00042010009","type":"CDM"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":162.0,"discounted_cash":121.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM","code_information":[{"code":"Px00042010014","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":133.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM","code_information":[{"code":"Px00042010015","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97530 THERAPEUTIC ACTIVITIES EA 15 MIN","code_information":[{"code":"Px00042010028","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE - PER DAY","code_information":[{"code":"Px00042010108","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":259.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":176.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ELEC STIMJ UNATTENDED","code_information":[{"code":"Px00042010113","type":"CDM"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INFRARED THERAPY","code_information":[{"code":"Px00042010121","type":"CDM"},{"code":"97026","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ATTENDED ESTIM EA 15 MIN","code_information":[{"code":"Px00042010124","type":"CDM"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS CONTRAST BATHS EA 15 MIN","code_information":[{"code":"Px00042010126","type":"CDM"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ULTRASOUND EA 15 MIN","code_information":[{"code":"Px00042010127","type":"CDM"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":79.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010131","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":133.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010139","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EA 15 MIN GAIT TRAING W/STAIR","code_information":[{"code":"Px00042010142","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EACH 15 MINUTES MASSAGE","code_information":[{"code":"Px00042010144","type":"CDM"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":194.0,"discounted_cash":145.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC PROCEDURES GROUP 2 OR MORE INDIVIDUALS","code_information":[{"code":"Px00042010153","type":"CDM"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"Px00042010160","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC WHEELCHAIR MGMT EA 15 MIN","code_information":[{"code":"Px00042010165","type":"CDM"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP LTE/50 SQ CM","code_information":[{"code":"Px00042010188","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP GT/50 SQ CM","code_information":[{"code":"Px00042010195","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","code_information":[{"code":"Px00042010248","type":"CDM"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010264","type":"CDM"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN","code_information":[{"code":"Px00042050000","type":"CDM"},{"code":"98980","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN","code_information":[{"code":"Px00042050001","type":"CDM"},{"code":"98981","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":379.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SPEECH-HEARING THERAPY INDIV CDM","code_information":[{"code":"Px00042050002","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":207.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE CDM","code_information":[{"code":"Px00042050005","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SPEECH SOUND LANG COMPREHEN EXTENDED CDM","code_information":[{"code":"Px00042050006","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE CDM","code_information":[{"code":"Px00042050007","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR CDM","code_information":[{"code":"Px00042050008","type":"CDM"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER EXERCISES PX 1 OR MORE AREAS EACH 15MINS CDM","code_information":[{"code":"Px00042050009","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":128.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY NEUROMUSC REEDUCA PX 1 OR MORE AREAS EACH 15MINS CDM","code_information":[{"code":"Px00042050010","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PX 1 OR MORE AREAS EA 15 MIN GAIT TRAING W/STAIR CDM","code_information":[{"code":"Px00042050011","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER IVNTJ COG FUNCJ CNTCT 1ST 15MINS CDM","code_information":[{"code":"Px00042050012","type":"CDM"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER IVNTJ COG FUNCJ CNTCT EA ADDL 15MINS CDM","code_information":[{"code":"Px00042050013","type":"CDM"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042050014","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION MOD COMPLEX CDM","code_information":[{"code":"Px00042050015","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042050016","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT RE-EVAL EST PLAN CARE 20MINS CDM","code_information":[{"code":"Px00042050017","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":248.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042050018","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042050020","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT RE-EVAL EST PLAN CARE 30MINS CDM","code_information":[{"code":"Px00042050021","type":"CDM"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":248.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SELF-CARE/HOME MGMT TRAINING EACH 15MINS CDM","code_information":[{"code":"Px00042050022","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP CDM","code_information":[{"code":"Px00042050023","type":"CDM"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":260.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15MINS CDM","code_information":[{"code":"Px00042050025","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL REM THER MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30 DAYS","code_information":[{"code":"Px00042050026","type":"CDM"},{"code":"98977","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410066","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":408.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410067","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":408.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00042410068","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":408.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410070","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":408.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97535 SELF CARE MGMT TRAINING EA 15 MIN CDM","code_information":[{"code":"Px00043010005","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"Px00043010008","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION LOW COMPLEX","code_information":[{"code":"Px00043410045","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":380.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION MOD COMPLEXITY","code_information":[{"code":"Px00043410046","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":380.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00043410047","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":380.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":344.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":277.0,"discounted_cash":207.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPEECH LANG VOICE COMMJ AUDITRY - GROUP 2 OR MORE CDM","code_information":[{"code":"Px00044010024","type":"CDM"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"Px00044010042","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ASSESSMENT OF APHASIA PER HOUR","code_information":[{"code":"Px00044010074","type":"CDM"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":369.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":540.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM","code_information":[{"code":"Px00044010126","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM","code_information":[{"code":"Px00044010145","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":207.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION","code_information":[{"code":"Px00044410026","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MOTION FLUOROSCOPY/SWALLOW","code_information":[{"code":"Px00044410043","type":"CDM"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":597.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"Px00044410063","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2378.0,"discounted_cash":1783.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13476.0,"discounted_cash":10107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6630.0,"discounted_cash":4972.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TONSIL ASPIRATION CDM","code_information":[{"code":"Px00045000017","type":"CDM"},{"code":"45000017","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":553.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2748.0,"discounted_cash":2061.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":966.0,"discounted_cash":724.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED J TUBE REPLACEMENT CDM","code_information":[{"code":"Px00045000024","type":"CDM"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":533.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2748.0,"discounted_cash":2061.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":399.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2853.0,"discounted_cash":2139.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":16992.0,"discounted_cash":12744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED VBAC DELIVERY ONLY CDM","code_information":[{"code":"Px00045000082","type":"CDM"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED URETHRAL FB REMOVAL CDM","code_information":[{"code":"Px00045000084","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":533.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5758.0,"discounted_cash":4318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3580.0,"discounted_cash":2685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10050.0,"discounted_cash":7537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYTIC VENOUS THERAPY CDM","code_information":[{"code":"Px00045000090","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":9849.0,"discounted_cash":7386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6209.0,"discounted_cash":4656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1452.0,"discounted_cash":1089.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1452.0,"discounted_cash":1089.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2853.0,"discounted_cash":2139.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED SUBCONJUNCTIVAL INJECTION CDM","code_information":[{"code":"Px00045000098","type":"CDM"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.0,"discounted_cash":814.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2202.0,"discounted_cash":1651.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1092.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2412.0,"discounted_cash":1809.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESS FOREARM 1 SPACE CDM","code_information":[{"code":"Px00045000126","type":"CDM"},{"code":"25020","type":"HCPCS"}],"standard_charges":[{"gross_charge":4402.0,"discounted_cash":3301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY CDM","code_information":[{"code":"Px00045000127","type":"CDM"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":19597.0,"discounted_cash":14697.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":17041.0,"discounted_cash":12780.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"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":2171.0,"discounted_cash":1628.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":999.0,"discounted_cash":749.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":999.0,"discounted_cash":749.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7949.0,"discounted_cash":5961.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM CHEST CDM","code_information":[{"code":"Px00045000136","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":542.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US ED ABDOMEN LIMITED CDM","code_information":[{"code":"Px00045000139","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":455.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":487.0,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":519.0,"discounted_cash":389.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC US ED RETROPERITONEAL LIMITED CDM","code_information":[{"code":"Px00045000144","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":522.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED ACNE SURGERY CDM","code_information":[{"code":"Px00045001301","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CURETTAGE POSTPARTUM CDM","code_information":[{"code":"Px00045001309","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":758.0,"discounted_cash":568.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9849.0,"discounted_cash":7386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED INHALATION TREATMENT CDM","code_information":[{"code":"Px00045010003","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":289.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9042.0,"discounted_cash":6781.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6125.0,"discounted_cash":4593.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6125.0,"discounted_cash":4593.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6125.0,"discounted_cash":4593.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":987.0,"discounted_cash":740.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2750.0,"discounted_cash":2062.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3198.0,"discounted_cash":2398.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10756.0,"discounted_cash":8067.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10756.0,"discounted_cash":8067.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5377.0,"discounted_cash":4032.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3198.0,"discounted_cash":2398.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00045010019","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":197.0,"discounted_cash":147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1372.0,"discounted_cash":1029.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":820.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2853.0,"discounted_cash":2139.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":899.0,"discounted_cash":674.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":820.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1181.0,"discounted_cash":885.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":17654.0,"discounted_cash":13240.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1105.0,"discounted_cash":828.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING HIP CDM","code_information":[{"code":"Px00045010065","type":"CDM"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1303.0,"discounted_cash":977.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":634.0,"discounted_cash":475.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1901.0,"discounted_cash":1425.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5655.0,"discounted_cash":4241.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2444.0,"discounted_cash":1833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9849.0,"discounted_cash":7386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4920.0,"discounted_cash":3690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2352.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":218.0,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1101.0,"discounted_cash":825.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1765.0,"discounted_cash":1323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1418.0,"discounted_cash":1063.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":734.0,"discounted_cash":550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5069.0,"discounted_cash":3801.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3580.0,"discounted_cash":2685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3580.0,"discounted_cash":2685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00045010098","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2742.0,"discounted_cash":2056.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00045010099","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2748.0,"discounted_cash":2061.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2748.0,"discounted_cash":2061.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3580.0,"discounted_cash":2685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10597.0,"discounted_cash":7947.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":918.0,"discounted_cash":688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2750.0,"discounted_cash":2062.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED NASOPHARYNGOSCOPY CDM","code_information":[{"code":"Px00045010113","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE CDM","code_information":[{"code":"Px00045010115","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":8999.0,"discounted_cash":6749.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED VAGINAL DELIVERY ONLY CDM","code_information":[{"code":"Px00045010118","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DELIVER PLACENTA CDM","code_information":[{"code":"Px00045010119","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":8692.0,"discounted_cash":6519.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED SPONTANEOUS ABORTION FAC CDM","code_information":[{"code":"Px00045010121","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED SEXUAL ASSAULT EXAM CDM","code_information":[{"code":"Px00045010130","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2748.0,"discounted_cash":2061.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DISTAL RADIAL FRACTURE CDM","code_information":[{"code":"Px00045010138","type":"CDM"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1403.0,"discounted_cash":1052.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7853.0,"discounted_cash":5889.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS FEM/JUGULAR CDM","code_information":[{"code":"Px00045010143","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS OTHER VEIN CDM","code_information":[{"code":"Px00045010145","type":"CDM"},{"code":"36406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.0,"discounted_cash":828.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED NON-ROUTINE BL DRAW GT/3 YRS CDM","code_information":[{"code":"Px00045010146","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":821.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED VEIN ACCESS CUTDOWN LT/1 YR CDM","code_information":[{"code":"Px00045010148","type":"CDM"},{"code":"36420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":1021.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1249.0,"discounted_cash":936.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":713.0,"discounted_cash":534.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5556.0,"discounted_cash":4167.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2272.0,"discounted_cash":1704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5121.0,"discounted_cash":3840.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5244.0,"discounted_cash":3933.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7731.0,"discounted_cash":5798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7731.0,"discounted_cash":5798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1086.0,"discounted_cash":814.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7351.0,"discounted_cash":5513.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5943.0,"discounted_cash":4457.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":484.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":973.0,"discounted_cash":729.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1413.0,"discounted_cash":1059.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2071.0,"discounted_cash":1553.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3299.0,"discounted_cash":2474.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":612.0,"discounted_cash":459.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1460.0,"discounted_cash":1095.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2067.0,"discounted_cash":1550.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":320.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOURETHROSCOPY CDM","code_information":[{"code":"Px00045010230","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.0,"discounted_cash":1172.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4637.0,"discounted_cash":3477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":899.0,"discounted_cash":674.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":711.0,"discounted_cash":533.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":202.0,"discounted_cash":151.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":369.0,"discounted_cash":276.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1329.0,"discounted_cash":996.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1184.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":644.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":518.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":925.0,"discounted_cash":693.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1141.0,"discounted_cash":855.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2719.0,"discounted_cash":2039.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":417.0,"discounted_cash":312.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3904.0,"discounted_cash":2928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6583.0,"discounted_cash":4937.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":915.0,"discounted_cash":686.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5943.0,"discounted_cash":4457.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PLACEMENT SETON CDM","code_information":[{"code":"Px00045010301","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":11161.0,"discounted_cash":8370.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1362.0,"discounted_cash":1021.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1362.0,"discounted_cash":1021.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":561.0,"discounted_cash":420.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1092.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":437.0,"discounted_cash":327.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10756.0,"discounted_cash":8067.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2698.0,"discounted_cash":2023.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00045010318","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":401.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":480.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":561.0,"discounted_cash":420.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":697.0,"discounted_cash":522.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":697.0,"discounted_cash":522.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":765.0,"discounted_cash":573.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":954.0,"discounted_cash":715.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":954.0,"discounted_cash":715.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1024.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":831.0,"discounted_cash":623.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":831.0,"discounted_cash":623.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1060.0,"discounted_cash":795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1060.0,"discounted_cash":795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1276.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1276.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":911.0,"discounted_cash":683.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":911.0,"discounted_cash":683.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":989.0,"discounted_cash":741.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":989.0,"discounted_cash":741.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1734.0,"discounted_cash":1300.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":911.0,"discounted_cash":683.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1249.0,"discounted_cash":936.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":911.0,"discounted_cash":683.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":989.0,"discounted_cash":741.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1060.0,"discounted_cash":795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1060.0,"discounted_cash":795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1276.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1276.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1276.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1276.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1619.0,"discounted_cash":1214.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1619.0,"discounted_cash":1214.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1619.0,"discounted_cash":1214.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1619.0,"discounted_cash":1214.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1725.0,"discounted_cash":1293.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1772.0,"discounted_cash":1329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":479.0,"discounted_cash":359.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5284.0,"discounted_cash":3963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3580.0,"discounted_cash":2685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2542.0,"discounted_cash":1906.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2545.0,"discounted_cash":1908.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00045010410","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3580.0,"discounted_cash":2685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045010414","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":144.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2078.0,"discounted_cash":1558.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010416","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":2030.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":711.0,"discounted_cash":533.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3089.0,"discounted_cash":2316.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REV EYELID LAT CDM","code_information":[{"code":"Px00045010422","type":"CDM"},{"code":"21282","type":"HCPCS"}],"standard_charges":[{"gross_charge":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00045010423","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":306.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":511.0,"discounted_cash":383.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF URETHRA CDM","code_information":[{"code":"Px00045010427","type":"CDM"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2067.0,"discounted_cash":1550.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1201.0,"discounted_cash":900.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00045010434","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":838.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REDUCE TESTIS TORSION CDM","code_information":[{"code":"Px00045010435","type":"CDM"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":10597.0,"discounted_cash":7947.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00045010436","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5684.0,"discounted_cash":4263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6133.0,"discounted_cash":4599.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":15325.0,"discounted_cash":11493.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR VAGINA/PERINEUM CDM","code_information":[{"code":"Px00045010446","type":"CDM"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PELVIC EXAMINATION CDM","code_information":[{"code":"Px00045010447","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF CERVIX CDM","code_information":[{"code":"Px00045010451","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":1744.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00045010452","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DILATION AND CURETTAGE CDM","code_information":[{"code":"Px00045010454","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00045010455","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":715.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2444.0,"discounted_cash":1833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":899.0,"discounted_cash":674.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5943.0,"discounted_cash":4457.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":390.0,"discounted_cash":292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":672.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":363.0,"discounted_cash":272.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6079.0,"discounted_cash":4559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00045010475","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2509.0,"discounted_cash":1881.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6079.0,"discounted_cash":4559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CORNEA CDM","code_information":[{"code":"Px00045010479","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":306.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10050.0,"discounted_cash":7537.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6079.0,"discounted_cash":4559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":652.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2023.0,"discounted_cash":1517.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":218.0,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":488.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":933.0,"discounted_cash":699.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION FEMORAL CDM","code_information":[{"code":"Px00045010493","type":"CDM"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT PATELLAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010496","type":"CDM"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1772.0,"discounted_cash":1329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1772.0,"discounted_cash":1329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1772.0,"discounted_cash":1329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":957.0,"discounted_cash":717.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10756.0,"discounted_cash":8067.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10756.0,"discounted_cash":8067.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9837.0,"discounted_cash":7377.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1789.0,"discounted_cash":1341.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1234.0,"discounted_cash":925.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1234.0,"discounted_cash":925.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CHEMICAL CAUTERY TISSUE CDM","code_information":[{"code":"Px00045010525","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00045010530","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2246.0,"discounted_cash":1684.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00045010531","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":4709.0,"discounted_cash":3531.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00045010532","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":4709.0,"discounted_cash":3531.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00045010533","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":2246.0,"discounted_cash":1684.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":899.0,"discounted_cash":674.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":545.0,"discounted_cash":408.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":913.0,"discounted_cash":684.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2371.0,"discounted_cash":1778.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":17654.0,"discounted_cash":13240.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1362.0,"discounted_cash":1021.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00045010562","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00045010563","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":713.0,"discounted_cash":534.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1073.0,"discounted_cash":804.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7351.0,"discounted_cash":5513.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1320.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1320.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":713.0,"discounted_cash":534.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7351.0,"discounted_cash":5513.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":982.0,"discounted_cash":736.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7351.0,"discounted_cash":5513.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":488.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3450.0,"discounted_cash":2587.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3511.0,"discounted_cash":2633.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":561.0,"discounted_cash":420.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11367.0,"discounted_cash":8525.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":616.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3841.0,"discounted_cash":2880.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION CDM","code_information":[{"code":"Px00045010621","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":16992.0,"discounted_cash":12744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND CDM","code_information":[{"code":"Px00045010627","type":"CDM"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":6079.0,"discounted_cash":4559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2545.0,"discounted_cash":1908.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4238.0,"discounted_cash":3178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010632","type":"CDM"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":43140.0,"discounted_cash":32355.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW FRACTURE CDM","code_information":[{"code":"Px00045010633","type":"CDM"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED HAND TENDON RECONSTRUCTION CDM","code_information":[{"code":"Px00045010637","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CORRECTION OF BUNION CDM","code_information":[{"code":"Px00045010641","type":"CDM"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING CDM","code_information":[{"code":"Px00045010642","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDOPEXY BY STAPLING CDM","code_information":[{"code":"Px00045010645","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM","code_information":[{"code":"Px00045010647","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":17232.0,"discounted_cash":12924.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT CDM","code_information":[{"code":"Px00045010649","type":"CDM"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":20429.0,"discounted_cash":15321.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6209.0,"discounted_cash":4656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYE CDM","code_information":[{"code":"Px00045010663","type":"CDM"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":6209.0,"discounted_cash":4656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED HYMENOTOMY SIMPLE INCISION CDM","code_information":[{"code":"Px00045010665","type":"CDM"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3597.0,"discounted_cash":2697.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REPLANTATION DIGIT COMPLETE CDM","code_information":[{"code":"Px00045010675","type":"CDM"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6079.0,"discounted_cash":4559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":370.0,"discounted_cash":277.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1348.0,"discounted_cash":1011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED ESCHAROTOMY ADDL INCISION CDM","code_information":[{"code":"Px00045010684","type":"CDM"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00045010685","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":5284.0,"discounted_cash":3963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2509.0,"discounted_cash":1881.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9849.0,"discounted_cash":7386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR PALATE CDM","code_information":[{"code":"Px00045010690","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":17654.0,"discounted_cash":13240.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REVISE FINGER JOINT CDM","code_information":[{"code":"Px00045010691","type":"CDM"},{"code":"26535","type":"HCPCS"}],"standard_charges":[{"gross_charge":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5706.0,"discounted_cash":4279.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1920.0,"discounted_cash":1440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":960.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING UNNA BOOT CDM","code_information":[{"code":"Px00045010706","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8550.0,"discounted_cash":6412.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":26988.0,"discounted_cash":20241.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010713","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2272.0,"discounted_cash":1704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":354.0,"discounted_cash":265.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9849.0,"discounted_cash":7386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION HUMERAL CDM","code_information":[{"code":"Px00045010721","type":"CDM"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4920.0,"discounted_cash":3690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8029.0,"discounted_cash":6021.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM","code_information":[{"code":"Px00045010728","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5758.0,"discounted_cash":4318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION CHALAZION SINGLE CDM","code_information":[{"code":"Px00045010737","type":"CDM"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":570.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1362.0,"discounted_cash":1021.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":682.0,"discounted_cash":511.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3595.0,"discounted_cash":2696.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5526.0,"discounted_cash":4144.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":43140.0,"discounted_cash":32355.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":488.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":43140.0,"discounted_cash":32355.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":43140.0,"discounted_cash":32355.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2272.0,"discounted_cash":1704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00045010760","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":590.0,"discounted_cash":442.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1403.0,"discounted_cash":1052.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED FETAL NONSTRESS TEST CDM","code_information":[{"code":"Px00045010765","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1434.0,"discounted_cash":1075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":14167.0,"discounted_cash":10625.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5284.0,"discounted_cash":3963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":943.0,"discounted_cash":707.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":926.0,"discounted_cash":694.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2648.0,"discounted_cash":1986.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":820.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1923.0,"discounted_cash":1442.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1901.0,"discounted_cash":1425.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2291.0,"discounted_cash":1718.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":643.0,"discounted_cash":482.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8435.0,"discounted_cash":6326.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3721.0,"discounted_cash":2790.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":696.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2272.0,"discounted_cash":1704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1516.0,"discounted_cash":1137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2272.0,"discounted_cash":1704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PERQ CERVICOTHORACIC INJECT CDM","code_information":[{"code":"Px00045010809","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED PERQ LUMBOSACRAL INJECTION CDM","code_information":[{"code":"Px00045010811","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":43140.0,"discounted_cash":32355.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":713.0,"discounted_cash":534.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":384.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":638.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8550.0,"discounted_cash":6412.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1446.0,"discounted_cash":1084.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6271.0,"discounted_cash":4703.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":426.0,"discounted_cash":319.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4920.0,"discounted_cash":3690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5684.0,"discounted_cash":4263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8538.0,"discounted_cash":6403.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13493.0,"discounted_cash":10119.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2643.0,"discounted_cash":1982.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1819.0,"discounted_cash":1364.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1181.0,"discounted_cash":885.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3836.0,"discounted_cash":2877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3836.0,"discounted_cash":2877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED BX INTRANASAL MUCOSA CDM","code_information":[{"code":"Px00045010878","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":16992.0,"discounted_cash":12744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":16992.0,"discounted_cash":12744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9849.0,"discounted_cash":7386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4920.0,"discounted_cash":3690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9849.0,"discounted_cash":7386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4920.0,"discounted_cash":3690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5758.0,"discounted_cash":4318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":926.0,"discounted_cash":694.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":713.0,"discounted_cash":534.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":844.0,"discounted_cash":633.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3580.0,"discounted_cash":2685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2748.0,"discounted_cash":2061.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1267.0,"discounted_cash":950.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED REP PERINEAL APRCH CDM","code_information":[{"code":"Px00045010912","type":"CDM"},{"code":"45541","type":"HCPCS"}],"standard_charges":[{"gross_charge":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8496.0,"discounted_cash":6372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2748.0,"discounted_cash":2061.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1234.0,"discounted_cash":925.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5758.0,"discounted_cash":4318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":705.0,"discounted_cash":528.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8013.0,"discounted_cash":6009.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED ORCHIOPEXY INGUINAL CDM","code_information":[{"code":"Px00045010927","type":"CDM"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":11710.0,"discounted_cash":8782.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY VULVA CDM","code_information":[{"code":"Px00045010928","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":653.0,"discounted_cash":489.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":299.0,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY WITH EXPLORATION CDM","code_information":[{"code":"Px00045010933","type":"CDM"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION CHEMICAL CERVIX CDM","code_information":[{"code":"Px00045010936","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":589.0,"discounted_cash":441.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9348.0,"discounted_cash":7011.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2131.0,"discounted_cash":1598.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":915.0,"discounted_cash":686.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2818.0,"discounted_cash":2113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6209.0,"discounted_cash":4656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED RECON EYELID CDM","code_information":[{"code":"Px00045010959","type":"CDM"},{"code":"67950","type":"HCPCS"}],"standard_charges":[{"gross_charge":6079.0,"discounted_cash":4559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":761.0,"discounted_cash":570.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":124.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED VENOUS PRESSURE DETERMINATION CDM","code_information":[{"code":"Px00045010964","type":"CDM"},{"code":"93770","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":223.0,"discounted_cash":167.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":445.0,"discounted_cash":333.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6586.0,"discounted_cash":4939.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6630.0,"discounted_cash":4972.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5739.0,"discounted_cash":4304.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACT MIN WO PHOSP NOTIF CDM","code_information":[{"code":"Px00045010990","type":"CDM"},{"code":"TR450","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.0,"discounted_cash":3528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":729.0,"discounted_cash":546.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":634.0,"discounted_cash":475.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":413.0,"discounted_cash":309.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":864.0,"discounted_cash":648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":338.0,"discounted_cash":253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":864.0,"discounted_cash":648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":194.0,"discounted_cash":145.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":910.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":475.0,"discounted_cash":356.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":279.0,"discounted_cash":209.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":229.0,"discounted_cash":171.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":166.0,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":625.0,"discounted_cash":468.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1912.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2885.0,"discounted_cash":2163.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1475.0,"discounted_cash":1106.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1386.0,"discounted_cash":1039.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2387.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2387.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8986.0,"discounted_cash":6739.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2272.0,"discounted_cash":1704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3452.0,"discounted_cash":2589.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":982.0,"discounted_cash":736.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4089.0,"discounted_cash":3066.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":869.0,"discounted_cash":651.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":521.0,"discounted_cash":390.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9842.0,"discounted_cash":7381.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2853.0,"discounted_cash":2139.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1440.0,"discounted_cash":1080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1403.0,"discounted_cash":1052.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1403.0,"discounted_cash":1052.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED APPLY FINGER CAST CDM","code_information":[{"code":"Px00045013105","type":"CDM"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":354.0,"discounted_cash":265.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":291.0,"discounted_cash":218.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":291.0,"discounted_cash":218.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CYLINDER CAST APPLICATION CDM","code_information":[{"code":"Px00045013122","type":"CDM"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":794.0,"discounted_cash":595.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":420.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":338.0,"discounted_cash":253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF TOES CDM","code_information":[{"code":"Px00045013139","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED WINDOWING OF CAST CDM","code_information":[{"code":"Px00045013151","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":959.0,"discounted_cash":719.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2145.0,"discounted_cash":1608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1372.0,"discounted_cash":1029.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":15468.0,"discounted_cash":11601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00045013192","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00045013194","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":707.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00045013197","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":372.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY WITH BIOPSY CDM","code_information":[{"code":"Px00045013198","type":"CDM"},{"code":"31576","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1024.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8334.0,"discounted_cash":6250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY CDM","code_information":[{"code":"Px00045013201","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00045013202","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5284.0,"discounted_cash":3963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5284.0,"discounted_cash":3963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":16992.0,"discounted_cash":12744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1764.0,"discounted_cash":1323.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2730.0,"discounted_cash":2047.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1276.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2167.0,"discounted_cash":1625.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4588.0,"discounted_cash":3441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1498.0,"discounted_cash":1123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9407.0,"discounted_cash":7055.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":283.0,"discounted_cash":212.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1510.0,"discounted_cash":1132.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5758.0,"discounted_cash":4318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":926.0,"discounted_cash":694.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":800.0,"discounted_cash":600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":445.0,"discounted_cash":333.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":918.0,"discounted_cash":688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00045014038","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1489.0,"discounted_cash":1116.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":634.0,"discounted_cash":475.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1837.0,"discounted_cash":1377.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1436.0,"discounted_cash":1077.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED FAC PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00045014048","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1837.0,"discounted_cash":1377.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21871.0,"discounted_cash":16403.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4958.0,"discounted_cash":3718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4743.0,"discounted_cash":3557.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":17654.0,"discounted_cash":13240.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8541.0,"discounted_cash":6405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3996.0,"discounted_cash":2997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3321.0,"discounted_cash":2490.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CO/MEMBANE DIFFUSE CAPACITY","code_information":[{"code":"Px00046010012","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":392.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PULMONARY STRESS TESTING - SIX MINUTE WALK CDM","code_information":[{"code":"Px00046010048","type":"CDM"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":467.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","code_information":[{"code":"Px00046010055","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.0,"discounted_cash":599.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SPIROMETRY PRE POST BRONCHODILATOR CDM","code_information":[{"code":"Px00046010063","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":676.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST CDM","code_information":[{"code":"Px00046010089","type":"CDM"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":245.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PURE TONE AUDIOMETRY AIR ONLY","code_information":[{"code":"Px00047010003","type":"CDM"},{"code":"92552","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC POSITIONAL NYSTAGMUS TEST","code_information":[{"code":"Px00047010025","type":"CDM"},{"code":"92532","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":888.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD CDM","code_information":[{"code":"Px00047110025","type":"CDM"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":694.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS CDM","code_information":[{"code":"Px00047110105","type":"CDM"},{"code":"92558","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","code_information":[{"code":"Px00048010001","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":1886.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD","code_information":[{"code":"Px00048010059","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1087.0,"discounted_cash":815.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":306.0,"discounted_cash":229.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1919.0,"discounted_cash":1439.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","code_information":[{"code":"Px00048010074","type":"CDM"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":200.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1226.0,"discounted_cash":919.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2017.0,"discounted_cash":1512.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON","code_information":[{"code":"Px00048010094","type":"CDM"},{"code":"93291","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC REM INTERROG PM/LDLS PM/IDS LTE 90 DAYS TECH REVIEW","code_information":[{"code":"Px00048010099","type":"CDM"},{"code":"93296","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","code_information":[{"code":"Px00048010122","type":"CDM"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":1237.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":448.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":448.0,"discounted_cash":336.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC ECHO TTE 2D W DOPPLER COMPLETE","code_information":[{"code":"Px00048310003","type":"CDM"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.0,"discounted_cash":1512.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":736.0,"discounted_cash":552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2077.0,"discounted_cash":1557.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1016.0,"discounted_cash":762.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1226.0,"discounted_cash":919.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ET ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00051010016","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ET ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00051010017","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1  CDM","code_information":[{"code":"Px00051010403","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4  CDM","code_information":[{"code":"Px00051010404","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4  CDM","code_information":[{"code":"Px00051010420","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","code_information":[{"code":"Px00051010440","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE  CDM","code_information":[{"code":"Px00051010522","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":447.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HLTH RSK ASSESS PT FOCUSED","code_information":[{"code":"Px00051010524","type":"CDM"},{"code":"96160","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93245 EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS SCAN ANLYS R&I RHC","code_information":[{"code":"Px00052100019","type":"CDM"},{"code":"93245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":802.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93248 EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS R&I RHC","code_information":[{"code":"Px00052100020","type":"CDM"},{"code":"93248","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99417 PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES RHC","code_information":[{"code":"Px00052100021","type":"CDM"},{"code":"99417","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93241 EXTERNAL ECG REC GT/48HR LT/7D SCAN ALYS REPORT R&I RHC","code_information":[{"code":"Px00052100023","type":"CDM"},{"code":"93241","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":771.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93244 EXTERNAL ECG REC/ GT 48HRS/ UP TO 7 DAYS REVIEW & INTERPRET RHC","code_information":[{"code":"Px00052100024","type":"CDM"},{"code":"93244","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93018 CARDIO STRESS TEST INTERP & REPT RHC","code_information":[{"code":"Px00052100037","type":"CDM"},{"code":"93018","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93306 ECHO TTE 2D W/COLOR & DOP RHC","code_information":[{"code":"Px00052100038","type":"CDM"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":558.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93308 ECHO TTE 2D M-MODE LTD RHC","code_information":[{"code":"Px00052100039","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93350 ECHO STRESS TEST W/INTERP & REPT RHC","code_information":[{"code":"Px00052100044","type":"CDM"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93282 PRGRMG EVAL SINGLE IMPLANTABLE DFB RHC","code_information":[{"code":"Px00052100053","type":"CDM"},{"code":"93282","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":225.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93283 PRGRMG EVAL DUAL IMPLANTABLE DFB RHC","code_information":[{"code":"Px00052100054","type":"CDM"},{"code":"93283","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":277.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93284 PRGRMG EVAL MULT IMPLANTABLE DFB RHC","code_information":[{"code":"Px00052100055","type":"CDM"},{"code":"93284","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":299.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93294 REM INTERROG PM/LDLS PM LTE 90 DAYS PHYS/QHP RHC","code_information":[{"code":"Px00052100058","type":"CDM"},{"code":"93294","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93295 INTER DEV DEFB RMT 90DYS RHC","code_information":[{"code":"Px00052100059","type":"CDM"},{"code":"93295","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":102.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93298 REM INTERROG SCRMS LT 30 D PHYS OR QHP CDM RHC","code_information":[{"code":"Px00052100061","type":"CDM"},{"code":"93298","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":290.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93272 CARDIAC EVENT PHYS REVIEW & INTERP RHC","code_information":[{"code":"Px00052100064","type":"CDM"},{"code":"93272","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 10030 IMG GUIDED FLU COLLCTN DRG CATH SOFT TISS PERQ RHC","code_information":[{"code":"Px00052100082","type":"CDM"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":383.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 92250 FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT RHC","code_information":[{"code":"Px00052100164","type":"CDM"},{"code":"92250","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99177 INSTRUMENT BASED OCULAR SCR BI W/ONSITE ANALYSIS RHC","code_information":[{"code":"Px00052100208","type":"CDM"},{"code":"99177","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":14.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR G0405 EKG INTERPRET & REPORT PREV RHC","code_information":[{"code":"Px00052100210","type":"CDM"},{"code":"G0405","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 15853 REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA RHC","code_information":[{"code":"Px00052100224","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99459 PELVIC EXAMINATION ADD-ON RHC","code_information":[{"code":"Px00052100286","type":"CDM"},{"code":"99459","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93290 INTERROG DEV EVAL ICPMS PHYS OR QHP IN PERSON RHC","code_information":[{"code":"Px00052100287","type":"CDM"},{"code":"93290","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93297 REM INTERROG ICPMS LT 30 D PHYS OR QHP RHC","code_information":[{"code":"Px00052100288","type":"CDM"},{"code":"93297","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":172.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR SYNCH AUDIO-ONLY EST LOW 20 RHC","code_information":[{"code":"Px00052100323","type":"CDM"},{"code":"98013","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93312 ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISTN I&R RHC","code_information":[{"code":"Px00052100367","type":"CDM"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.0,"discounted_cash":669.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY RHC","code_information":[{"code":"Px00052100368","type":"CDM"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":539.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99188 APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP","code_information":[{"code":"Px00052110004","type":"CDM"},{"code":"99188","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR G0071 TELEPHONE/EVISIT SVCS BY RHC/FQHC 5 MIN","code_information":[{"code":"Px00052110008","type":"CDM"},{"code":"G0071","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99421 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/5-10 MINS RHC","code_information":[{"code":"Px00052110012","type":"CDM"},{"code":"99421","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99422 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/11-20 MINS RHC","code_information":[{"code":"Px00052110013","type":"CDM"},{"code":"99422","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99423 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/21 OR MORE MIN RHC","code_information":[{"code":"Px00052110014","type":"CDM"},{"code":"99423","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE RHC","code_information":[{"code":"Px00052110016","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST RHC","code_information":[{"code":"Px00052110019","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM OR LESS RHC","code_information":[{"code":"Px00052110027","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":174.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 RHC","code_information":[{"code":"Px00052110032","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11056 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 RHC","code_information":[{"code":"Px00052110033","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11057 PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 RHC","code_information":[{"code":"Px00052110034","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION RHC","code_information":[{"code":"Px00052110035","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":107.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION RHC","code_information":[{"code":"Px00052110037","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11105 PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION RHC","code_information":[{"code":"Px00052110038","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11106 INCISIONAL BIOPSY SKIN SINGLE LESION RHC","code_information":[{"code":"Px00052110039","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":162.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 RHC","code_information":[{"code":"Px00052110041","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":223.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11300 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/OR LESS RHC","code_information":[{"code":"Px00052110043","type":"CDM"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":96.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11306 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM RHC","code_information":[{"code":"Px00052110048","type":"CDM"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS RHC","code_information":[{"code":"Px00052110055","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":246.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11401 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM RHC","code_information":[{"code":"Px00052110056","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11402 EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM RHC","code_information":[{"code":"Px00052110057","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":336.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11403 EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM RHC","code_information":[{"code":"Px00052110058","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":438.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11404 EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM RHC","code_information":[{"code":"Px00052110059","type":"CDM"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":483.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11406 EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM RHC","code_information":[{"code":"Px00052110060","type":"CDM"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":724.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11421 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM RHC","code_information":[{"code":"Px00052110062","type":"CDM"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":318.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11422 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM RHC","code_information":[{"code":"Px00052110063","type":"CDM"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":398.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11423 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM RHC","code_information":[{"code":"Px00052110064","type":"CDM"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":462.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11442 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM RHC","code_information":[{"code":"Px00052110069","type":"CDM"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":429.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11602 EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM RHC","code_information":[{"code":"Px00052110078","type":"CDM"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":467.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11606 EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM RHC","code_information":[{"code":"Px00052110081","type":"CDM"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1216.0,"discounted_cash":912.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11622 EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM RHC","code_information":[{"code":"Px00052110084","type":"CDM"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":489.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11624 EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM RHC","code_information":[{"code":"Px00052110086","type":"CDM"},{"code":"11624","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"discounted_cash":686.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER RHC","code_information":[{"code":"Px00052110094","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11721 DEBRIDEMENT NAIL ANY METHOD 6/> RHC","code_information":[{"code":"Px00052110095","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 RHC","code_information":[{"code":"Px00052110096","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL RHC","code_information":[{"code":"Px00052110099","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11770 EXCISION PILONIDAL CYST/SINUS SIMPLE RHC","code_information":[{"code":"Px00052110103","type":"CDM"},{"code":"11770","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":537.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11981 INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT RHC","code_information":[{"code":"Px00052110113","type":"CDM"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":181.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11982 REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT RHC","code_information":[{"code":"Px00052110114","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":209.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11983 RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT RHC","code_information":[{"code":"Px00052110115","type":"CDM"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 17000 DESTRUCTION PREMALIGNANT LESION 1ST RHC","code_information":[{"code":"Px00052110173","type":"CDM"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 17110 DESTRUCTION BENIGN LESIONS UP TO 14 RHC","code_information":[{"code":"Px00052110177","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 17250 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE RHC","code_information":[{"code":"Px00052110179","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 17340 CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE RHC","code_information":[{"code":"Px00052110198","type":"CDM"},{"code":"17340","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION RHC","code_information":[{"code":"Px00052110204","type":"CDM"},{"code":"19120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.0,"discounted_cash":1224.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 20526 INJECTION THERAPEUTIC CARPAL TUNNEL RHC","code_information":[{"code":"Px00052110216","type":"CDM"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":164.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS RHC","code_information":[{"code":"Px00052110218","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US RHC","code_information":[{"code":"Px00052110219","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":102.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US RHC","code_information":[{"code":"Px00052110220","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 21552 EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> RHC","code_information":[{"code":"Px00052110234","type":"CDM"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1748.0,"discounted_cash":1311.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC RHC","code_information":[{"code":"Px00052110314","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29130 APPLICATION FINGER SPLINT STATIC RHC","code_information":[{"code":"Px00052110315","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29435 APPLICATION PATELLAR TENDON BEARING CAST RHC","code_information":[{"code":"Px00052110320","type":"CDM"},{"code":"29435","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":253.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29710 RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET RHC","code_information":[{"code":"Px00052110325","type":"CDM"},{"code":"29710","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC RHC","code_information":[{"code":"Px00052110389","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":107.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 58301 REMOVAL INTRAUTERINE DEVICE IUD RHC","code_information":[{"code":"Px00052110541","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":189.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R RHC","code_information":[{"code":"Px00052110607","type":"CDM"},{"code":"93000","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93010 ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY RHC","code_information":[{"code":"Px00052110609","type":"CDM"},{"code":"93010","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93016 CV STRS TST XERS&/OR RX CONT ECG W/O I&R RHC","code_information":[{"code":"Px00052110610","type":"CDM"},{"code":"93016","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I RHC","code_information":[{"code":"Px00052110613","type":"CDM"},{"code":"93224","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93227 XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS RHC","code_information":[{"code":"Px00052110616","type":"CDM"},{"code":"93227","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93279 PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER RHC","code_information":[{"code":"Px00052110619","type":"CDM"},{"code":"93279","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93280 PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER RHC","code_information":[{"code":"Px00052110620","type":"CDM"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93281 PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER RHC","code_information":[{"code":"Px00052110621","type":"CDM"},{"code":"93281","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93288 INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM RHC","code_information":[{"code":"Px00052110623","type":"CDM"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93289 INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB RHC","code_information":[{"code":"Px00052110624","type":"CDM"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":203.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93291 INTERROGATION EVALUATION IN PERSON ILR SYSTEM RHC","code_information":[{"code":"Px00052110625","type":"CDM"},{"code":"93291","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93293 TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL RHC","code_information":[{"code":"Px00052110626","type":"CDM"},{"code":"93293","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":119.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG RHC","code_information":[{"code":"Px00052110627","type":"CDM"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":660.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 94640 AIRWAY INHALATION TREATMENT RHC","code_information":[{"code":"Px00052110636","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 96110 DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM RHC","code_information":[{"code":"Px00052110649","type":"CDM"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 96160 PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM RHC","code_information":[{"code":"Px00052110650","type":"CDM"},{"code":"96160","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 96161 CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM RHC","code_information":[{"code":"Px00052110651","type":"CDM"},{"code":"96161","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS RHC","code_information":[{"code":"Px00052110660","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 98966 NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN RHC","code_information":[{"code":"Px00052110672","type":"CDM"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 98967 NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN RHC","code_information":[{"code":"Px00052110673","type":"CDM"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 98968 NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN RHC","code_information":[{"code":"Px00052110674","type":"CDM"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99075 MEDICAL TESTIMONY RHC","code_information":[{"code":"Px00052110677","type":"CDM"},{"code":"99075","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99202 OFFICE OUTPATIENT NEW RHC","code_information":[{"code":"Px00052110681","type":"CDM"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99203 OFFICE OUTPATIENT NEW RHC","code_information":[{"code":"Px00052110682","type":"CDM"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":235.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99204 OFFICE OUTPATIENT NEW RHC","code_information":[{"code":"Px00052110683","type":"CDM"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":383.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99205 OFFICE OUTPATIENT NEW RHC","code_information":[{"code":"Px00052110684","type":"CDM"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":521.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99211 OFFICE OUTPATIENT VISIT RHC","code_information":[{"code":"Px00052110685","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99212 OFFICE OUTPATIENT VISIT RHC","code_information":[{"code":"Px00052110687","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99213 OFFICE OUTPATIENT VISIT RHC","code_information":[{"code":"Px00052110688","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99214 OFFICE OUTPATIENT VISIT RHC","code_information":[{"code":"Px00052110689","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":278.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99215 OFFICE OUTPATIENT VISIT RHC","code_information":[{"code":"Px00052110690","type":"CDM"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":411.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES RHC","code_information":[{"code":"Px00052110694","type":"CDM"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":383.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99245 OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES RHC","code_information":[{"code":"Px00052110695","type":"CDM"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99308 SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES RHC","code_information":[{"code":"Px00052110705","type":"CDM"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99309 SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES RHC","code_information":[{"code":"Px00052110706","type":"CDM"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":309.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99347 HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES RHC","code_information":[{"code":"Px00052110725","type":"CDM"},{"code":"99347","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":129.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99348 HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES RHC","code_information":[{"code":"Px00052110726","type":"CDM"},{"code":"99348","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":219.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99349 HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES RHC","code_information":[{"code":"Px00052110727","type":"CDM"},{"code":"99349","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":363.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99350 HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES RHC","code_information":[{"code":"Px00052110728","type":"CDM"},{"code":"99350","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":528.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99358 PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR RHC","code_information":[{"code":"Px00052110733","type":"CDM"},{"code":"99358","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":252.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99359 PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES RHC","code_information":[{"code":"Px00052110734","type":"CDM"},{"code":"99359","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":103.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99382 INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS RHC","code_information":[{"code":"Px00052110746","type":"CDM"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":223.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99383 INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS RHC","code_information":[{"code":"Px00052110747","type":"CDM"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99384 PREVENTIVE VISIT NEW 12-17  RHC","code_information":[{"code":"Px00052110748","type":"CDM"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC","code_information":[{"code":"Px00052110749","type":"CDM"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":268.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99386 PREVENTIVE VISIT NEW 40-64  RHC","code_information":[{"code":"Px00052110750","type":"CDM"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":325.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99387 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> RHC","code_information":[{"code":"Px00052110751","type":"CDM"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":349.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99391 PERIODIC PREVENTIVE MED ESTABLISHED PT/YOUNGER THAN 1 YR RHC","code_information":[{"code":"Px00052110752","type":"CDM"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":189.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99392 PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS RHC","code_information":[{"code":"Px00052110753","type":"CDM"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99393 PREV VISIT EST AGE 5-11  RHC","code_information":[{"code":"Px00052110754","type":"CDM"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99394 PREVENTIVE VISIT EST 12-17 RHC","code_information":[{"code":"Px00052110755","type":"CDM"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99395 PREVENTIVE VISIT EST 18-39  RHC","code_information":[{"code":"Px00052110756","type":"CDM"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":246.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99396 PREVENTIVE VISIT EST 40-64  RHC","code_information":[{"code":"Px00052110757","type":"CDM"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":267.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99397 PREVENTIVE VISIT EST 65 & OVER RHC","code_information":[{"code":"Px00052110758","type":"CDM"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN RHC","code_information":[{"code":"Px00052110763","type":"CDM"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99495 TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE RHC","code_information":[{"code":"Px00052110792","type":"CDM"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":398.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99496 TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE RHC","code_information":[{"code":"Px00052110793","type":"CDM"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":541.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR G0402 INITIAL PREVENTIVE EXAM RHC","code_information":[{"code":"Px00052110803","type":"CDM"},{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR G0438 PPPS INITIAL VISIT  RHC","code_information":[{"code":"Px00052110805","type":"CDM"},{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":476.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR G0439 PPPS SUBSEQ VISIT RHC","code_information":[{"code":"Px00052110806","type":"CDM"},{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":375.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR G0444 DEPRESSION SCREEN ANNUAL RHC","code_information":[{"code":"Px00052110808","type":"CDM"},{"code":"G0444","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR Q0091 OBTAINING SCREEN PAP SMEAR RHC","code_information":[{"code":"Px00052110824","type":"CDM"},{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES RHC","code_information":[{"code":"Px00052110833","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES RHC","code_information":[{"code":"Px00052110834","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":119.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US RHC","code_information":[{"code":"Px00052110836","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":130.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29075 APPLICATION CAST ELBOW FINGER SHORT ARM RHC","code_information":[{"code":"Px00052110866","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29105 APPLICATION LONG ARM SPLINT SHOULDER HAND RHC","code_information":[{"code":"Px00052110867","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE RHC","code_information":[{"code":"Px00052110870","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":171.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29515 APPLICATION SHORT LEG SPLINT CALF FOOT RHC","code_information":[{"code":"Px00052110873","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29540 STRAPPING ANKLE &/FOOT RHC","code_information":[{"code":"Px00052110874","type":"CDM"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 46083 INCISION THROMBOSED HEMORRHOID EXTERNAL RHC","code_information":[{"code":"Px00052110879","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":322.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 58300 INSERTION INTRAUTERINE DEVICE IUD RHC","code_information":[{"code":"Px00052110889","type":"CDM"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":144.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT RHC","code_information":[{"code":"Px00052110895","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 95115 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX RHC","code_information":[{"code":"Px00052110898","type":"CDM"},{"code":"95115","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 95117 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS RHC","code_information":[{"code":"Px00052110899","type":"CDM"},{"code":"95117","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 96127 BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT RHC","code_information":[{"code":"Px00052110901","type":"CDM"},{"code":"96127","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM RHC","code_information":[{"code":"Px00052110906","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE RHC","code_information":[{"code":"Px00052120000","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":311.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE RHC","code_information":[{"code":"Px00052120001","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":534.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC CATH HEMO 13FR 15CM CRV DUAL","code_information":[{"code":"Px0005626150L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR REGIONAL SUPPLIES"}]},{"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":605.0,"discounted_cash":453.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI IMAGE JAW JOINT TMJ","code_information":[{"code":"Px00061010002","type":"CDM"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.0,"discounted_cash":1317.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK WO & W CONTRAST","code_information":[{"code":"Px00061010007","type":"CDM"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":1863.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO CONTRAST","code_information":[{"code":"Px00061010009","type":"CDM"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.0,"discounted_cash":1093.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD W CONTRAST","code_information":[{"code":"Px00061010010","type":"CDM"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2320.0,"discounted_cash":1740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO & W CONTRAST","code_information":[{"code":"Px00061010012","type":"CDM"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":3182.0,"discounted_cash":2386.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO CONTRAST","code_information":[{"code":"Px00061010013","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.0,"discounted_cash":1093.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRA NECK W CONTRAST","code_information":[{"code":"Px00061010014","type":"CDM"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1147.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO & W CONTRAST","code_information":[{"code":"Px00061010015","type":"CDM"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":2303.0,"discounted_cash":1727.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010019","type":"CDM"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":1651.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO & W CONTRAST","code_information":[{"code":"Px00061010025","type":"CDM"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2588.0,"discounted_cash":1941.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO CONTRAST","code_information":[{"code":"Px00061010029","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":1651.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061010044","type":"CDM"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":3739.0,"discounted_cash":2804.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010053","type":"CDM"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":2045.0,"discounted_cash":1533.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010054","type":"CDM"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.0,"discounted_cash":1300.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010059","type":"CDM"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4240.0,"discounted_cash":3180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010063","type":"CDM"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.0,"discounted_cash":1444.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010065","type":"CDM"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":1816.0,"discounted_cash":1362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010066","type":"CDM"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.0,"discounted_cash":1584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010068","type":"CDM"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4240.0,"discounted_cash":3180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010075","type":"CDM"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.0,"discounted_cash":1309.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010077","type":"CDM"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":2136.0,"discounted_cash":1602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010079","type":"CDM"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":2336.0,"discounted_cash":1752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI MRCP ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010082","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":1651.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010083","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":1651.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN W/O DYE LIMITED","code_information":[{"code":"Px00061010084","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":1651.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN W CONTRAST","code_information":[{"code":"Px00061010085","type":"CDM"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.0,"discounted_cash":3004.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO & W CONTRAST","code_information":[{"code":"Px00061010087","type":"CDM"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.0,"discounted_cash":3004.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH","code_information":[{"code":"Px00061010090","type":"CDM"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":455.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH W/WO DYE","code_information":[{"code":"Px00061010092","type":"CDM"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.0,"discounted_cash":718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2222.0,"discounted_cash":1666.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2102.0,"discounted_cash":1576.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2325.0,"discounted_cash":1743.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2235.0,"discounted_cash":1676.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST BILATERAL","code_information":[{"code":"Px00061010280","type":"CDM"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":471.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL","code_information":[{"code":"Px00061010281","type":"CDM"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":3282.0,"discounted_cash":2461.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL","code_information":[{"code":"Px00061010282","type":"CDM"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":3311.0,"discounted_cash":2483.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2242.0,"discounted_cash":1681.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/O DYE LIMITED","code_information":[{"code":"Px00061110002","type":"CDM"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.0,"discounted_cash":1681.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE","code_information":[{"code":"Px00061110007","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.0,"discounted_cash":2025.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/O & W/DYE","code_information":[{"code":"Px00061110015","type":"CDM"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":3091.0,"discounted_cash":2318.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE","code_information":[{"code":"Px00061210001","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":2411.0,"discounted_cash":1808.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/DYE","code_information":[{"code":"Px00061210003","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":1854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O DYE","code_information":[{"code":"Px00061210005","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":2633.0,"discounted_cash":1974.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2154.0,"discounted_cash":1615.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210010","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1615.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/DYE","code_information":[{"code":"Px00061210011","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.0,"discounted_cash":2025.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE","code_information":[{"code":"Px00061210013","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":3894.0,"discounted_cash":2920.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4105.0,"discounted_cash":3078.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O & W/DYE","code_information":[{"code":"Px00061210017","type":"CDM"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":4084.0,"discounted_cash":3063.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":222.0,"discounted_cash":166.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":222.0,"discounted_cash":166.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":222.0,"discounted_cash":166.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":222.0,"discounted_cash":166.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX MENINGOCOCCAL CONJ QUADRIVALENT (MENQUADFI) IM 1 EA","code_information":[{"code":"Px00063600101","type":"CDM"},{"code":"90619","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX RSV PREF BIVALENT IM 1 EA","code_information":[{"code":"Px00063600152","type":"CDM"},{"code":"90678","type":"HCPCS"}],"standard_charges":[{"gross_charge":2084.56,"discounted_cash":1563.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":118.43,"discounted_cash":88.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":175.56,"discounted_cash":131.67,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":175.56,"discounted_cash":131.67,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":175.56,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":175.56,"discounted_cash":131.67,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"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":262.2,"discounted_cash":196.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":262.2,"discounted_cash":196.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":262.2,"discounted_cash":196.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":262.2,"discounted_cash":196.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX RSV MONOCLONAL ANTIBODY IM 0.5 ML","code_information":[{"code":"Px00063600172","type":"CDM"},{"code":"90380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.72,"discounted_cash":1251.54,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1668.72,"discounted_cash":1251.54,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1668.72,"discounted_cash":1251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":1668.72,"discounted_cash":1251.54,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX RSV MONOCLONAL ANTIBODY IM 1 ML","code_information":[{"code":"Px00063600173","type":"CDM"},{"code":"90381","type":"HCPCS"}],"standard_charges":[{"gross_charge":2867.96,"discounted_cash":2150.97,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2867.96,"discounted_cash":2150.97,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2867.96,"discounted_cash":2150.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":2867.96,"discounted_cash":2150.97,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX METHYLPREDNISOLONE ACETATE INJ 1 MG","code_information":[{"code":"Px00063600184","type":"CDM"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC PR RX METHYLPREDNISOLONE ACETATE INJ 20MG/1MG","code_information":[{"code":"Px00063600188","type":"CDM"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.99,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2.65,"discounted_cash":1.99,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2.65,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX METHYLPREDNISOLONE ACETATE INJ 40MG/1MG","code_information":[{"code":"Px00063600189","type":"CDM"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":1.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1.33,"discounted_cash":1.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1.33,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX METHYLPREDNISOLONE ACETATE INJ 80MG/1MG","code_information":[{"code":"Px00063600191","type":"CDM"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":0.66,"discounted_cash":0.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1.11,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX METHYLPREDNISOLONE SODIUM SUCCINATE INJ 40MG/5MG","code_information":[{"code":"Px00063600192","type":"CDM"},{"code":"J2919","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2.0,"discounted_cash":1.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":11.13,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX METHYLPREDNISOLONE SODIUM SUCCINATE INJ 125MG/5MG","code_information":[{"code":"Px00063600193","type":"CDM"},{"code":"J2919","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYALURONAN OR DERIVATIVE (GEL-SYN) INJ 0.1 MG","code_information":[{"code":"Px00063600232","type":"CDM"},{"code":"J7328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2407.3,"discounted_cash":1805.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":2407.3,"discounted_cash":1805.48,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC INJ PERFLUTREN LIP MICROS,ML","code_information":[{"code":"Px00063610012","type":"CDM"},{"code":"Q9957","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":488.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":52.0,"discounted_cash":39.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":52.0,"discounted_cash":39.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":226.0,"discounted_cash":169.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HEPATITIS A VACCINE PEDIATRIC 2 DOSE IM 0.5 ML","code_information":[{"code":"Px00063610052","type":"CDM"},{"code":"90633","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":57.0,"discounted_cash":42.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":65.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":65.0,"discounted_cash":48.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX MEASLES MUMPS RUBELLA VACCINE LIVE SQ 1 EA","code_information":[{"code":"Px00063610054","type":"CDM"},{"code":"90707","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":96.0,"discounted_cash":72.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX POLIOVIRUS VACCINE INACTIVATED SQ/IM 0.5 ML","code_information":[{"code":"Px00063610055","type":"CDM"},{"code":"90713","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":49.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":49.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX VARICELLA VACCINE LIVE SQ 0.5 ML","code_information":[{"code":"Px00063610057","type":"CDM"},{"code":"90716","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":150.0,"discounted_cash":112.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":156.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":156.0,"discounted_cash":117.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"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":32.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":32.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":72.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ONABOTULINUMTOXINA INJ 1 UNIT","code_information":[{"code":"Px00063610063","type":"CDM"},{"code":"J0585","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":318.0,"discounted_cash":238.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":318.0,"discounted_cash":238.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":318.0,"discounted_cash":238.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX INFLUENZA QUADRIVALENT INH 0.2 ML","code_information":[{"code":"Px00063610069","type":"CDM"},{"code":"90672","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX MEASLES MUMPS RUBELLA VARICELLA VACCINE LIVE SQ 0.5 ML","code_information":[{"code":"Px00063610070","type":"CDM"},{"code":"90710","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX RISPERIDONE INJ 0.5 MG","code_information":[{"code":"Px00063610077","type":"CDM"},{"code":"J2794","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.25 ML","code_information":[{"code":"Px00063610083","type":"CDM"},{"code":"90685","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":128.5,"discounted_cash":96.38,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":128.5,"discounted_cash":96.38,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":128.5,"discounted_cash":96.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":128.5,"discounted_cash":96.38,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML","code_information":[{"code":"Px00063610089","type":"CDM"},{"code":"90651","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":200.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DTAP-IPV-HIB-HEPB VACCINE IM 1 EA","code_information":[{"code":"Px00063610090","type":"CDM"},{"code":"90697","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":148.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"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":123.0,"discounted_cash":92.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":123.0,"discounted_cash":92.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":379.09,"discounted_cash":284.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":379.09,"discounted_cash":284.32,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX LEVONORGESTREL (KYLEENA) IUD 19.5 MG","code_information":[{"code":"Px00063610108","type":"CDM"},{"code":"J7296","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":1072.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYDROXYPROGESTERONE (MAKENA) INJ 10 MG","code_information":[{"code":"Px00063610110","type":"CDM"},{"code":"J1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX IIV VACCINE PF INCREASED AG CONTENT IM 1 EA","code_information":[{"code":"Px00063610111","type":"CDM"},{"code":"90662","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":32.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX HEPB VACCINE ADULT 2 DOSE IM 1 EA","code_information":[{"code":"Px00063610116","type":"CDM"},{"code":"90739","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.9,"discounted_cash":175.43,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX LEUPROLIDE ACETATE INJ 7.5 MG","code_information":[{"code":"Px00063610120","type":"CDM"},{"code":"J9217","type":"HCPCS"}],"standard_charges":[{"gross_charge":4614.0,"discounted_cash":3460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX LEUPROLIDE ACETATE INJ 3.75 MG","code_information":[{"code":"Px00063610122","type":"CDM"},{"code":"J1950","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":204.25,"discounted_cash":153.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":286.0,"discounted_cash":214.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":286.0,"discounted_cash":214.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":26.0,"discounted_cash":19.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":26.0,"discounted_cash":19.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYALURONAN OR DERIVATIVE (MONOVISC) INJ 1 EA","code_information":[{"code":"Px00063610168","type":"CDM"},{"code":"J7327","type":"HCPCS"}],"standard_charges":[{"gross_charge":6004.89,"discounted_cash":4503.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX BETAMETHASONE ACET&SOD PHOSP INJ 3 MG","code_information":[{"code":"Px00063610180","type":"CDM"},{"code":"J0702","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":56.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYALURONAN OR DERIVATIVE (GEL-ONE) INJ 1 EA","code_information":[{"code":"Px00063610188","type":"CDM"},{"code":"J7326","type":"HCPCS"}],"standard_charges":[{"gross_charge":3628.0,"discounted_cash":2721.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":197.0,"discounted_cash":147.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":197.0,"discounted_cash":147.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":955.0,"discounted_cash":716.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX LEVONORGESTREL (LILETTA) IUD 6 YR 52 MG","code_information":[{"code":"Px00063610216","type":"CDM"},{"code":"J7297","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX LEVONORGESTREL IUD (MIRENA) IUD 5 YR 52 MG","code_information":[{"code":"Px00063610217","type":"CDM"},{"code":"J7298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DEPO-ESTRADIOL CYPIONATE INJ 5 MG","code_information":[{"code":"Px00063610233","type":"CDM"},{"code":"J1000","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":48.0,"discounted_cash":36.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM 0.5 ML","code_information":[{"code":"Px00063610239","type":"CDM"},{"code":"90738","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":251.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DEGARELIX INJ 1 MG","code_information":[{"code":"Px00063610241","type":"CDM"},{"code":"J9155","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 0.5 ML","code_information":[{"code":"Px00063610243","type":"CDM"},{"code":"90620","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX INFLUENZA QUADRIVALENT PF IM 0.5 ML","code_information":[{"code":"Px00063610246","type":"CDM"},{"code":"90674","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML","code_information":[{"code":"Px00063610248","type":"CDM"},{"code":"90750","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX TRIAMCINOLONE ACETATE INJ 10 MG","code_information":[{"code":"Px00063610250","type":"CDM"},{"code":"J3301","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":6.0,"discounted_cash":4.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ONDANSETRON ORAL 4 MG","code_information":[{"code":"Px00063610259","type":"CDM"},{"code":"S0119","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ESTRADIOL VALERATE INJ 10 MG","code_information":[{"code":"Px00063610260","type":"CDM"},{"code":"J1380","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HALOPERIDOL DECANOATE INJ 50 MG","code_information":[{"code":"Px00063610262","type":"CDM"},{"code":"J1631","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX NALTREXONE INJ 1 MG","code_information":[{"code":"Px00063610263","type":"CDM"},{"code":"J2315","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ONDANSETRON ORAL 4 MG","code_information":[{"code":"Px00063610265","type":"CDM"},{"code":"J2405","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX PALIPERIDONE PALMITATE INJ 1 MG","code_information":[{"code":"Px00063610266","type":"CDM"},{"code":"J2426","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX INFLUENZA TRIVALENT LAIV3 INH 0.2 ML","code_information":[{"code":"Px00063610273","type":"CDM"},{"code":"90660","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.44,"discounted_cash":49.08,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":65.44,"discounted_cash":49.08,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR RX ALBUTEROL NON-COMPOUNDED CONCENTRATED UNIT DOSE INH 1 MG","code_information":[{"code":"Px00063610277","type":"CDM"},{"code":"J7613","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX CEFTRIAXONE SODIUM INJ 250 MG","code_information":[{"code":"Px00063610278","type":"CDM"},{"code":"J0696","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":48.0,"discounted_cash":36.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":89.0,"discounted_cash":66.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX CLONIDINE HCL INJ 1 MG","code_information":[{"code":"Px00063610279","type":"CDM"},{"code":"J0735","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DEXAMETHASONE SODIUM PHOSPHATE INJ 1 MG","code_information":[{"code":"Px00063610280","type":"CDM"},{"code":"J1100","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX KETOROLAC TROMETHAMINE INJ 15 MG","code_information":[{"code":"Px00063610289","type":"CDM"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":24.0,"discounted_cash":18.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX 4VHPV VACCINE 3 DOSE IM 0.5 ML","code_information":[{"code":"Px00063610293","type":"CDM"},{"code":"90649","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":114.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":153.0,"discounted_cash":114.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":251.0,"discounted_cash":188.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACC/YOUNGER THAN 7 YRS/IM","code_information":[{"code":"Px00063610294","type":"CDM"},{"code":"90700","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":40.0,"discounted_cash":30.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":42.0,"discounted_cash":31.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML","code_information":[{"code":"Px00063610295","type":"CDM"},{"code":"90723","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":131.0,"discounted_cash":98.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML","code_information":[{"code":"Px00063610296","type":"CDM"},{"code":"90696","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":30.0,"discounted_cash":22.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX DTAP-IPV/HIB VACCINE IM 0.5 ML","code_information":[{"code":"Px00063610297","type":"CDM"},{"code":"90698","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HEPB VACCINE ADOLESCENT 2 DOSE IM 1 ML","code_information":[{"code":"Px00063610298","type":"CDM"},{"code":"90743","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":82.0,"discounted_cash":61.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":72.0,"discounted_cash":54.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":72.0,"discounted_cash":54.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HEPB VACCINE PED/ADOLESC 3 DOSE IM 0.5 ML","code_information":[{"code":"Px00063610300","type":"CDM"},{"code":"90744","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":30.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":40.0,"discounted_cash":30.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":40.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HIB PRP-OMP VACCINE 3 DOSE IM 0.5 ML","code_information":[{"code":"Px00063610301","type":"CDM"},{"code":"90647","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":33.0,"discounted_cash":24.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":34.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HIB PRP-T VACCINE 4 DOSE IM 1 EA","code_information":[{"code":"Px00063610302","type":"CDM"},{"code":"90648","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HIB-HEPB VACCINE IM 1 EA","code_information":[{"code":"Px00063610303","type":"CDM"},{"code":"90748","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":113.85,"discounted_cash":85.39,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":113.85,"discounted_cash":85.39,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":113.85,"discounted_cash":85.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":113.85,"discounted_cash":85.39,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR RX MENACWYD/MENACWY-CRM CONJ VACCINE GRPS ACYW IM 0.5 ML","code_information":[{"code":"Px00063610305","type":"CDM"},{"code":"90734","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":144.0,"discounted_cash":108.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX MENB-FHBP RECOMBNT LIPOPROTEIN VACCINE 2/3 DOSE IM 0.5 ML","code_information":[{"code":"Px00063610306","type":"CDM"},{"code":"90621","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG","code_information":[{"code":"Px00063610308","type":"CDM"},{"code":"90378","type":"HCPCS"}],"standard_charges":[{"gross_charge":3012.0,"discounted_cash":2259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ROTOVIRUS VACCINE (RV1) 2 DOSE ORAL 1 EA","code_information":[{"code":"Px00063610309","type":"CDM"},{"code":"90681","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ROTOVIRUS VACCINE (RV5) 3 DOSE ORAL 2 ML","code_information":[{"code":"Px00063610310","type":"CDM"},{"code":"90680","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":189.0,"discounted_cash":141.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":198.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX TYPHOID VACCINE LIVE ORAL 1 EA","code_information":[{"code":"Px00063610311","type":"CDM"},{"code":"90690","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":171.0,"discounted_cash":128.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":171.0,"discounted_cash":128.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":94.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM 0.5 ML","code_information":[{"code":"Px00063610315","type":"CDM"},{"code":"90691","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":75.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX TRIPTORELIN PAMOATE INJ 3.75 MG","code_information":[{"code":"Px00063610325","type":"CDM"},{"code":"J3315","type":"HCPCS"}],"standard_charges":[{"gross_charge":2615.0,"discounted_cash":1961.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":842.0,"discounted_cash":631.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX VITAMIN K INJ 1 MG","code_information":[{"code":"Px00063610328","type":"CDM"},{"code":"J3430","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ACETAMINOPHEN ORAL 1 EA","code_information":[{"code":"Px00063610329","type":"CDM"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX SODIUM BICARBONATE INJ 1 MEQ/ML","code_information":[{"code":"Px00063610332","type":"CDM"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX NORMAL SALINE INFUSION 1000 ML","code_information":[{"code":"Px00063610333","type":"CDM"},{"code":"J7030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX LEVONORGESTREL (SKYLA) IUD 13.5 MG","code_information":[{"code":"Px00063610334","type":"CDM"},{"code":"J7301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":799.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ETONOGESTREL IMPLANT 1 EA","code_information":[{"code":"Px00063610335","type":"CDM"},{"code":"J7307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":802.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1070.0,"discounted_cash":802.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1113.0,"discounted_cash":834.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYALURONAN OR DERIVATIVE (EUFLEXXA) INJ 1 EA","code_information":[{"code":"Px00063610336","type":"CDM"},{"code":"J7323","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYALURONAN OR DERIVATIVE (ORTHOVISC) INJ 1 EA","code_information":[{"code":"Px00063610337","type":"CDM"},{"code":"J7324","type":"HCPCS"}],"standard_charges":[{"gross_charge":1585.0,"discounted_cash":1188.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1585.0,"discounted_cash":1188.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1643.0,"discounted_cash":1232.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYALURONAN OR DERIVATIVE (SYNVISC OR SYNVISC-ONE) INJ 1","code_information":[{"code":"Px00063610338","type":"CDM"},{"code":"J7325","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":26.0,"discounted_cash":19.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX METHOTREXATE SODIUM INJ 50 MG","code_information":[{"code":"Px00063610340","type":"CDM"},{"code":"J9260","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ONDANSETRON (SUBSTITUTE FOR IV ANTIEMETIC WITH CHEMO) ORAL 1 MG","code_information":[{"code":"Px00063610341","type":"CDM"},{"code":"Q0162","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DARBEPOETIN ALFA NON-ESRD INJ 1 MCG","code_information":[{"code":"Px00063610344","type":"CDM"},{"code":"J0881","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DIGOXIN INJ 0.5 MG","code_information":[{"code":"Px00063610345","type":"CDM"},{"code":"J1160","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DMSO 50% INJ 50 ML","code_information":[{"code":"Px00063610346","type":"CDM"},{"code":"J1212","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYDROCORTISONE NA SUCCINATE INJ 100 MG","code_information":[{"code":"Px00063610347","type":"CDM"},{"code":"J1720","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX PROGESTERONE INJ 50 MG","code_information":[{"code":"Px00063610348","type":"CDM"},{"code":"J2675","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYDROXYZINE INJ 25 MG","code_information":[{"code":"Px00063610349","type":"CDM"},{"code":"J3410","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX GOSERLIN ACETATE IMPLANT 3.6 MG","code_information":[{"code":"Px00063610351","type":"CDM"},{"code":"J9202","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":544.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX MITOMYCIN INJ 5 MG","code_information":[{"code":"Px00063610352","type":"CDM"},{"code":"J9280","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX PROCHLORPERAZINE INJ 10 MG","code_information":[{"code":"Px00063610355","type":"CDM"},{"code":"J0780","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ENOXAPARIN SODIUM INJ 10 MG","code_information":[{"code":"Px00063610356","type":"CDM"},{"code":"J1650","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX LACTATE RINGERS INF 1000 ML","code_information":[{"code":"Px00063610359","type":"CDM"},{"code":"J7120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX LEVALBUTEROL NON-COMPOUNDED INH 0.5 MG","code_information":[{"code":"Px00063610360","type":"CDM"},{"code":"J7614","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ARIPIPRAZOLE ER INJ 1 MG","code_information":[{"code":"Px00063610365","type":"CDM"},{"code":"J0401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX COSYNTROPIN INJ 0.25 MG","code_information":[{"code":"Px00063610511","type":"CDM"},{"code":"J0834","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX BCG LIVE INTRAVESICAL 1 MG","code_information":[{"code":"Px00063610514","type":"CDM"},{"code":"J9030","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HYALURONAN OR DERIVATIVE (HYALGAN, SUPARTZ OR VISCO-3) INJ 1 EA","code_information":[{"code":"Px00063610515","type":"CDM"},{"code":"J7321","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX PENICILLIN G BENZATHINE INJ 100000 UNITS","code_information":[{"code":"Px00063610523","type":"CDM"},{"code":"J0561","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX INTRAUTERINE COPPER CONTRACEPTIVE IUD 1 EA","code_information":[{"code":"Px00063610524","type":"CDM"},{"code":"J7300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":908.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX HEPARIN SODIUM INJ 1000 UNITS","code_information":[{"code":"Px00063610526","type":"CDM"},{"code":"J1644","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX MEPERIDINE HCL INJ 100 MG","code_information":[{"code":"Px00063610533","type":"CDM"},{"code":"J2175","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX MORPHINE SULFATE INJ 10 MG","code_information":[{"code":"Px00063610534","type":"CDM"},{"code":"J2270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ONDANSETRON HCL INJ 1 MG","code_information":[{"code":"Px00063610535","type":"CDM"},{"code":"J2405","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX PROMETHAZINE HCL INJ 50 MG","code_information":[{"code":"Px00063610536","type":"CDM"},{"code":"J2550","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":59.0,"discounted_cash":44.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3.0,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX SUMATRIPTAN SUCCINATE INJ 6 MG","code_information":[{"code":"Px00063610541","type":"CDM"},{"code":"J3030","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX DIPHENHYDRAMINE HCL INJ 50 MG","code_information":[{"code":"Px00063610545","type":"CDM"},{"code":"J1200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ALBUTEROL NON-COMPOUNDED CONCENTRATED INH 1 MG","code_information":[{"code":"Px00063610546","type":"CDM"},{"code":"J7611","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX ALBUTEROL/IPRATROPIUM BROMIDE NONCMPNDD INH UP TO 2.5MG/0.5 MG 1EA","code_information":[{"code":"Px00063610547","type":"CDM"},{"code":"J7620","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR RX MEDROXYPROGESTERONE ACETATE 1 MG","code_information":[{"code":"Px00063610549","type":"CDM"},{"code":"J1050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1.0,"discounted_cash":0.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5739.0,"discounted_cash":4304.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION PARTIAL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210002","type":"CDM"}],"standard_charges":[{"gross_charge":1994.0,"discounted_cash":1495.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION FULL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210104","type":"CDM"}],"standard_charges":[{"gross_charge":3853.0,"discounted_cash":2889.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6586.0,"discounted_cash":4939.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS II - 1ST HOUR","code_information":[{"code":"Px00071010113","type":"CDM"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":605.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS II - ADDL 15 MIN","code_information":[{"code":"Px00071010114","type":"CDM"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":104.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS III - 1ST HOUR","code_information":[{"code":"Px00071010117","type":"CDM"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":761.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS III - ADDL 15 MIN","code_information":[{"code":"Px00071010118","type":"CDM"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS IV - 1ST HOUR","code_information":[{"code":"Px00071010120","type":"CDM"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":761.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL 15","code_information":[{"code":"Px00071010131","type":"CDM"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 INITIAL 15","code_information":[{"code":"Px00071010132","type":"CDM"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 INITIAL 15","code_information":[{"code":"Px00071010133","type":"CDM"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":263.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 INITIAL 15","code_information":[{"code":"Px00071010134","type":"CDM"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 INITIAL 15","code_information":[{"code":"Px00071010135","type":"CDM"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 PER MIN","code_information":[{"code":"Px00071010231","type":"CDM"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 PER MIN","code_information":[{"code":"Px00071010232","type":"CDM"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 PER MIN","code_information":[{"code":"Px00071010233","type":"CDM"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 PER MIN","code_information":[{"code":"Px00071010234","type":"CDM"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 PER MIN","code_information":[{"code":"Px00071010358","type":"CDM"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 1 CDM","code_information":[{"code":"Px00072210001","type":"CDM"}],"standard_charges":[{"gross_charge":5955.0,"discounted_cash":4466.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 2 CDM","code_information":[{"code":"Px00072210002","type":"CDM"}],"standard_charges":[{"gross_charge":7384.0,"discounted_cash":5538.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 3 CDM","code_information":[{"code":"Px00072210003","type":"CDM"}],"standard_charges":[{"gross_charge":9290.0,"discounted_cash":6967.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 4 CDM","code_information":[{"code":"Px00072210004","type":"CDM"}],"standard_charges":[{"gross_charge":11314.0,"discounted_cash":8485.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NEWBORN RESUSCITATION NICU/LD","code_information":[{"code":"Px00072210210","type":"CDM"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1733.0,"discounted_cash":1299.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CIRCUMCISION W/REGIONL BLOCK CDM","code_information":[{"code":"Px00072310001","type":"CDM"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":364.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ECG 12 LEAD TRACING ONLY","code_information":[{"code":"Px00073010002","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INIT PREVNT EXAM SCREEN EKG, TRACING ONLY","code_information":[{"code":"Px00073010219","type":"CDM"},{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":24.0,"discounted_cash":18.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS RECORDING CDM","code_information":[{"code":"Px00073100001","type":"CDM"},{"code":"93246","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS SCAN ANLYS W/REPORT CDM","code_information":[{"code":"Px00073100002","type":"CDM"},{"code":"93247","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 48 HRS/ UP TO 7DAYS RECORDING CDM","code_information":[{"code":"Px00073100003","type":"CDM"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 48 HRS/ UP TO 7 DAYS ANALYSIS W/REPORT CDM","code_information":[{"code":"Px00073100004","type":"CDM"},{"code":"93243","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HOLTER MONITOR UP TO 48 HRS","code_information":[{"code":"Px00073110001","type":"CDM"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2215.0,"discounted_cash":1661.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HOLTER MONITOR ANALYSIS & REPT","code_information":[{"code":"Px00073110002","type":"CDM"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CARDIAC EVENT MONITOR SET UP","code_information":[{"code":"Px00073210001","type":"CDM"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.0,"discounted_cash":670.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ECG/MONITORING AND ANALYSIS PT HOME ACTIVATED UP TO 30DAYS","code_information":[{"code":"Px00073210002","type":"CDM"},{"code":"93271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":795.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY 4 OR MORE","code_information":[{"code":"Px00074010009","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2864.0,"discounted_cash":2148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EEG EXTENDED MONITORING 41-60 MINUTES","code_information":[{"code":"Px00074010013","type":"CDM"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EEG EXTENDED MONITORING 61-119 MINUTES","code_information":[{"code":"Px00074010014","type":"CDM"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","code_information":[{"code":"Px00074010015","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00074010018","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR CDM","code_information":[{"code":"Px00074010059","type":"CDM"},{"code":"95706","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":779.0,"discounted_cash":584.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1327.0,"discounted_cash":995.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1327.0,"discounted_cash":995.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VID TECH EA INCR 12-26 HR CONT R-T MNTR CDM","code_information":[{"code":"Px00074010063","type":"CDM"},{"code":"95710","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":995.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HOME SLEEP TEST/TYPE 3 PORTABLE","code_information":[{"code":"Px00074010123","type":"CDM"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":559.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 6","code_information":[{"code":"Px00075010272","type":"CDM"}],"standard_charges":[{"gross_charge":16366.0,"discounted_cash":12274.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 1","code_information":[{"code":"Px00075010315","type":"CDM"}],"standard_charges":[{"gross_charge":3912.0,"discounted_cash":2934.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 2","code_information":[{"code":"Px00075010316","type":"CDM"}],"standard_charges":[{"gross_charge":6796.0,"discounted_cash":5097.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 3","code_information":[{"code":"Px00075010317","type":"CDM"}],"standard_charges":[{"gross_charge":8234.0,"discounted_cash":6175.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 4","code_information":[{"code":"Px00075010318","type":"CDM"}],"standard_charges":[{"gross_charge":9927.0,"discounted_cash":7445.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 5","code_information":[{"code":"Px00075010319","type":"CDM"}],"standard_charges":[{"gross_charge":14412.0,"discounted_cash":10809.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 1 CDM","code_information":[{"code":"Px00076100001","type":"CDM"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":149.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 2 CDM","code_information":[{"code":"Px00076100002","type":"CDM"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":149.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 3 CDM","code_information":[{"code":"Px00076100003","type":"CDM"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":204.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 4 CDM","code_information":[{"code":"Px00076100004","type":"CDM"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 5 CDM","code_information":[{"code":"Px00076100005","type":"CDM"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":282.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CLTX DSTL FIBULAR LAT MALLS FX W/MANIP CDM","code_information":[{"code":"Px00076100229","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110004","type":"CDM"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110005","type":"CDM"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110006","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FACILITY ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110007","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FACILITY ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110008","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FACILITY ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110009","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FACILITY ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110010","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FACILITY ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110011","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110021","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":338.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110039","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":210.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110040","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110041","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE ABSCESS SKIN COMPLICATED/MULTIPLE CDM","code_information":[{"code":"Px00076110171","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INSTILL BLADDER ANTICARCINOGENIC AGENT CDM","code_information":[{"code":"Px00076110205","type":"CDM"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":217.0,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC REFILL MAINT PORTABLE PUMP CDM","code_information":[{"code":"Px00076110305","type":"CDM"},{"code":"96521","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":453.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IRRIGATION IMPLANTED VAD","code_information":[{"code":"Px00076110307","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT NAIL ANY METHOD 6/GT CDM","code_information":[{"code":"Px00076110454","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":143.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":251.0,"discounted_cash":188.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":400.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":444.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HOSPITAL OBSERVATION PER HR CDM","code_information":[{"code":"Px00076210001","type":"CDM"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":424.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC COVID 19 IMMUNIZATION SINGLE DOSE ADMIN CDM","code_information":[{"code":"Px00077100046","type":"CDM"},{"code":"90480","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":71.0,"discounted_cash":53.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN RSV MONOC ANTB IM W/ CNSL CDM","code_information":[{"code":"Px00077100049","type":"CDM"},{"code":"96380","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ADMIN RSV MONOC ANTB IM CDM","code_information":[{"code":"Px00077100052","type":"CDM"},{"code":"96381","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN CDM","code_information":[{"code":"Px00077110001","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN EACH ADD CDM","code_information":[{"code":"Px00077110002","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ADMIN INFLUENZA VIRUS VAC CDM","code_information":[{"code":"Px00077110003","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ADMIN PNEUMOCOCCAL VACCINE CDM","code_information":[{"code":"Px00077110004","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ADMIN HEPATITIS B VACCINE CDM","code_information":[{"code":"Px00077110005","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ADMIN VACCINE INITIAL LTE 18 YEARS OLD CDM","code_information":[{"code":"Px00077110223","type":"CDM"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":88.0,"discounted_cash":66.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN IMM LTE 18 YRS ANY RTE EA ADDL VAC/TOX COMPT CDM","code_information":[{"code":"Px00077110224","type":"CDM"},{"code":"90461","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":33.0,"discounted_cash":24.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN VACCINE INITIAL CDM","code_information":[{"code":"Px00077110225","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 90472 ADMIN VACCINE EA ADDL CDM","code_information":[{"code":"Px00077110226","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN VACCINE INITIAL INTRANASAL/ORAL CDM","code_information":[{"code":"Px00077110227","type":"CDM"},{"code":"90473","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":64.0,"discounted_cash":48.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN VACCINE INITIAL INTRANASAL/ORAL EA ADDL CDM","code_information":[{"code":"Px00077110228","type":"CDM"},{"code":"90474","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":46.0,"discounted_cash":34.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN VACCINE INFLUENZA CDM","code_information":[{"code":"Px00077110233","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN VACCINE PNEUMONIA CDM","code_information":[{"code":"Px00077110234","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR ADMIN VACCINE HEPATITIS B CDM","code_information":[{"code":"Px00077110235","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":79.0,"discounted_cash":59.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC TELEHEALTH FACILITY FEE Q3014 CDM","code_information":[{"code":"Px00078010001","type":"CDM"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEHEALTH VISIT HOSP FACILITY FEE","code_information":[{"code":"Px00078010004","type":"CDM"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TELEH MENTAL HLTH BY HOSP EMPLYED QMP 15-29 MIN C7900 CDM","code_information":[{"code":"Px00090000064","type":"CDM"},{"code":"C7900","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TELEH MENTAL HLTH BY HOSP EMPLYED QMP INITIAL 30-60 MIN C7901 CDM","code_information":[{"code":"Px00090000065","type":"CDM"},{"code":"C7901","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":142.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC TELEH MENTAL HLTH BY HOSP EMPLYED QMP EA ADDL 15 MIN C7902 CDM","code_information":[{"code":"Px00090000066","type":"CDM"},{"code":"C7902","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PSYCH DIAG EVAL CDM","code_information":[{"code":"Px00090000072","type":"CDM"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":400.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90785 PSYCTX COMPLEX INTERACT ADD-ON RHC","code_information":[{"code":"Px00090010041","type":"CDM"},{"code":"90785","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90791 PSYCH DIAG EVAL RHC","code_information":[{"code":"Px00090010042","type":"CDM"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90832 PSYTX W PT 30 MIN RHC","code_information":[{"code":"Px00090010043","type":"CDM"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":204.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90834 PSYTX W PT 45 MIN RHC","code_information":[{"code":"Px00090010044","type":"CDM"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90837 PSYTX W PT 60 MIN RHC","code_information":[{"code":"Px00090010045","type":"CDM"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":516.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96161 HLTH RISK ASSMT SCORE DOC STD INSTRUM ADD-ON RHC","code_information":[{"code":"Px00090010079","type":"CDM"},{"code":"96161","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96156 ASSESS/REASSESS HEALTH BEHAV RHC","code_information":[{"code":"Px00090010086","type":"CDM"},{"code":"96156","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":257.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96158 INTERVNT HEALTH BEHAV INDIV 1ST 30 MIN RHC","code_information":[{"code":"Px00090010087","type":"CDM"},{"code":"96158","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN CDM","code_information":[{"code":"Px00090010088","type":"CDM"},{"code":"96159","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PSYCHOTHERAPY W PT 45 MIN CDM","code_information":[{"code":"Px00091410047","type":"CDM"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PSYCHOTHERAPY W PT 60 MIN CDM","code_information":[{"code":"Px00091410111","type":"CDM"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":171.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PSYCHOTHERAPY W PT 30 MIN CDM","code_information":[{"code":"Px00091410112","type":"CDM"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MLT FAM GROUP BHV MGMT/MODIFICAJ TRAING 1ST 60 CDM","code_information":[{"code":"Px00091500010","type":"CDM"},{"code":"96202","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MLT FAM GROUP BHV MGMT/MODIFICAJ TRAING EA ADDL 15 MIN CDM","code_information":[{"code":"Px00091500011","type":"CDM"},{"code":"96203","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INTERVNT HEALTH BEHAV GROUP 1ST 30 MIN CDM","code_information":[{"code":"Px00091510097","type":"CDM"},{"code":"96164","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN CDM","code_information":[{"code":"Px00091510098","type":"CDM"},{"code":"96165","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INTERVNT HEALTH BEHAV PT W FAMILY 1ST 30 MIN CDM","code_information":[{"code":"Px00091610043","type":"CDM"},{"code":"96167","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN CDM","code_information":[{"code":"Px00091610044","type":"CDM"},{"code":"96168","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DEMONSTRATE USE HOME INR MON","code_information":[{"code":"Px00092010009","type":"CDM"},{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":374.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PROVIDE INR TEST MATER/EQUIP","code_information":[{"code":"Px00092010010","type":"CDM"},{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":328.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC FETAL NON-STRESS TEST CDM","code_information":[{"code":"Px00092010032","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1434.0,"discounted_cash":1075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC SLP STDY UNATTENDED","code_information":[{"code":"Px00092010106","type":"CDM"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":398.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1128.0,"discounted_cash":846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","code_information":[{"code":"Px00092110003","type":"CDM"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","code_information":[{"code":"Px00092110010","type":"CDM"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":741.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":988.0,"discounted_cash":741.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","code_information":[{"code":"Px00092110013","type":"CDM"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","code_information":[{"code":"Px00092110015","type":"CDM"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":958.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","code_information":[{"code":"Px00092110016","type":"CDM"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":1150.0,"discounted_cash":862.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"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":850.0,"discounted_cash":637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","code_information":[{"code":"Px00092110019","type":"CDM"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN HEMODIALYSIS ACCESS","code_information":[{"code":"Px00092110024","type":"CDM"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":412.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC BEHAV CHNG SMOKING 3-10 MIN","code_information":[{"code":"Px00094010003","type":"CDM"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC ACTINOTHERAPY ULTRAVIOLET LIGHT","code_information":[{"code":"Px00094010052","type":"CDM"},{"code":"96900","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THERAPUTIC PHLEBOTOMY","code_information":[{"code":"Px00094010204","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INJ SQ OR IM CDM","code_information":[{"code":"Px00094010205","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC INJ IV PUSH INITIAL DRUG CDM","code_information":[{"code":"Px00094010207","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":356.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC INJ IV PUSH SEQUENTIAL NEW DRUG CDM","code_information":[{"code":"Px00094010208","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":209.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC CDM","code_information":[{"code":"Px00094010209","type":"CDM"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210013","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DIAB MANAGE TRN PER INDIV 30 MIN CDM","code_information":[{"code":"Px00094210071","type":"CDM"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC DIAB MANAGE TRN GROUP 30 MIN CDM","code_information":[{"code":"Px00094210088","type":"CDM"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC MNT SUBS TX FOR CHANGE DX (G0270)","code_information":[{"code":"Px00094210089","type":"CDM"},{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC GROUP MNT 2 OR MORE 30 MINS","code_information":[{"code":"Px00094210090","type":"CDM"},{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT/LESS THAN 30 MINS","code_information":[{"code":"Px00094210100","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 30 MIN","code_information":[{"code":"Px00094210105","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":293.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 60 MIN","code_information":[{"code":"Px00094210106","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 90 MIN","code_information":[{"code":"Px00094210303","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":465.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN","code_information":[{"code":"Px00096010015","type":"CDM"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99407 BEHAV CHNG SMOKING > 10 MIN","code_information":[{"code":"Px00096010017","type":"CDM"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51798 MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00096010041","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99495 TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE CDM","code_information":[{"code":"Px00096010047","type":"CDM"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":597.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":796.0,"discounted_cash":597.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":531.0,"discounted_cash":398.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99496 TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE CDM","code_information":[{"code":"Px00096010048","type":"CDM"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":809.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1079.0,"discounted_cash":809.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":722.0,"discounted_cash":541.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 97606 NEG PRESS WOUND TX UTILIZING DME EQUIP >50SQ CM","code_information":[{"code":"Px00096010051","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":75.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 77071 XR MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","code_information":[{"code":"Px00096011111","type":"CDM"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","code_information":[{"code":"Px00096110037","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":292.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":390.0,"discounted_cash":292.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","code_information":[{"code":"Px00096110046","type":"CDM"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":305.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":407.0,"discounted_cash":305.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES","code_information":[{"code":"Px00096110059","type":"CDM"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":312.0,"discounted_cash":234.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":273.0,"discounted_cash":204.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES","code_information":[{"code":"Px00096110061","type":"CDM"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":309.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":412.0,"discounted_cash":309.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES","code_information":[{"code":"Px00096110063","type":"CDM"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":458.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":611.0,"discounted_cash":458.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":532.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN","code_information":[{"code":"Px00096110065","type":"CDM"},{"code":"90839","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":441.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":588.0,"discounted_cash":441.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION","code_information":[{"code":"Px00096110069","type":"CDM"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":495.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":660.0,"discounted_cash":495.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":566.0,"discounted_cash":424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96127 BRIEF EMOTIONAL/BEHAV ASSMT","code_information":[{"code":"Px00096110077","type":"CDM"},{"code":"96127","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96156 HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT CDM","code_information":[{"code":"Px00096110101","type":"CDM"},{"code":"96156","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":294.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":392.0,"discounted_cash":294.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":343.0,"discounted_cash":257.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96158 HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN CDM","code_information":[{"code":"Px00096110102","type":"CDM"},{"code":"96158","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96159 HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN CDM","code_information":[{"code":"Px00096110103","type":"CDM"},{"code":"96159","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":60.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96164 HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN CDM","code_information":[{"code":"Px00096110104","type":"CDM"},{"code":"96164","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96165 HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN CDM","code_information":[{"code":"Px00096110105","type":"CDM"},{"code":"96165","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96167 HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN CDM","code_information":[{"code":"Px00096110106","type":"CDM"},{"code":"96167","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":187.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96168 HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN CDM","code_information":[{"code":"Px00096110107","type":"CDM"},{"code":"96168","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96170 HEALTH BEHAVIOR IVNTJ FAM WO PT F2F 1ST 30 MIN CDM","code_information":[{"code":"Px00096110108","type":"CDM"},{"code":"96170","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96171 HEALTH BEHAVIOR IVNTJ FAM WO PT F2F EA ADDL 15 CDM","code_information":[{"code":"Px00096110109","type":"CDM"},{"code":"96171","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":108.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 92250 FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT CDM","code_information":[{"code":"Px00096200008","type":"CDM"},{"code":"92250","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01937 ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP CRV/THRC CDM","code_information":[{"code":"Px00096300013","type":"CDM"},{"code":"01937","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01938 ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP LMBR/SAC CDM","code_information":[{"code":"Px00096300014","type":"CDM"},{"code":"01938","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01939 ANES PERQ IMG DSTRJ PX NULYT AGT SPI/SP CRV/THRC CDM","code_information":[{"code":"Px00096300015","type":"CDM"},{"code":"01939","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01940 ANES PERQ IMG DSTRJ PX NULYT AGT SPI/SP LMBR/SAC CDM","code_information":[{"code":"Px00096300016","type":"CDM"},{"code":"01940","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01941 ANES PERQ IMG NEUROMD/NTRVRT PX SPI/SP CRV/THRC CDM","code_information":[{"code":"Px00096300017","type":"CDM"},{"code":"01941","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01942 ANES PERQ IMG NEUROMD/NTRVRT PX SPI/SP LMBR/SAC CDM","code_information":[{"code":"Px00096300018","type":"CDM"},{"code":"01942","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00103 ANESTHESIA EYELID RECONSTRUCTIVE PROCEDURE CDM","code_information":[{"code":"Px00096310003","type":"CDM"},{"code":"00103","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.84,"discounted_cash":484.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00140 ANESTHESIA EYE NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00096310008","type":"CDM"},{"code":"00140","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.84,"discounted_cash":484.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00142 ANESTH LENS SURGERY","code_information":[{"code":"Px00096310009","type":"CDM"},{"code":"00142","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00170 ANESTHESIA INTRAORAL WITH BIOPSY NOS CDM","code_information":[{"code":"Px00096310017","type":"CDM"},{"code":"00170","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.84,"discounted_cash":484.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00300 ANESTH HEAD/NECK/PTRUNK","code_information":[{"code":"Px00096310023","type":"CDM"},{"code":"00300","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00320 ANES ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR","code_information":[{"code":"Px00096310024","type":"CDM"},{"code":"00320","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00350 ANESTH NECK VESSEL SURGERY","code_information":[{"code":"Px00096310026","type":"CDM"},{"code":"00350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.88,"discounted_cash":1245.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00352 ANESTH NECK VESSEL SURGERY","code_information":[{"code":"Px00096310027","type":"CDM"},{"code":"00352","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00400 ANESTH SKIN EXT/PER/ATRUNK","code_information":[{"code":"Px00096310028","type":"CDM"},{"code":"00400","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00402 ANESTH SURGERY OF BREAST","code_information":[{"code":"Px00096310029","type":"CDM"},{"code":"00402","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00404 ANESTH SURGERY OF BREAST RADICAL","code_information":[{"code":"Px00096310030","type":"CDM"},{"code":"00404","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00406 ANESTH SURGERY OF BREAST RAD OR MOD W/ INT MAM","code_information":[{"code":"Px00096310031","type":"CDM"},{"code":"00406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.2,"discounted_cash":1622.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00410 ANESTH CORRECT HEART RHYTHM","code_information":[{"code":"Px00096310032","type":"CDM"},{"code":"00410","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00450 ANESTH SURGERY OF SHOULDER","code_information":[{"code":"Px00096310033","type":"CDM"},{"code":"00450","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00470 ANESTH REMOVAL OF RIB","code_information":[{"code":"Px00096310035","type":"CDM"},{"code":"00470","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00472 ANESTH CHEST WALL REPAIR","code_information":[{"code":"Px00096310036","type":"CDM"},{"code":"00472","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.88,"discounted_cash":1245.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00500 ANESTH ESOPHAGEAL SURGERY","code_information":[{"code":"Px00096310038","type":"CDM"},{"code":"00500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.08,"discounted_cash":1873.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00520 ANESTH CHEST PROCEDURE","code_information":[{"code":"Px00096310039","type":"CDM"},{"code":"00520","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00524 ANESTH CHEST DRAINAGE","code_information":[{"code":"Px00096310041","type":"CDM"},{"code":"00524","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00528 ANESTH MEDIASCPY & DX THORSCPY","code_information":[{"code":"Px00096310042","type":"CDM"},{"code":"00528","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00529 ANESTH MEDSCPY&THORSCPY 1 LUNG W/VENT","code_information":[{"code":"Px00096310043","type":"CDM"},{"code":"00529","type":"HCPCS"}],"standard_charges":[{"gross_charge":1827.28,"discounted_cash":1370.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00530 ANESTH PACEMAKER INSERTION","code_information":[{"code":"Px00096310044","type":"CDM"},{"code":"00530","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00532 ANESTH VASCULAR ACCESS","code_information":[{"code":"Px00096310045","type":"CDM"},{"code":"00532","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00534 ANESTH CARDIOVERTER/DEFIB","code_information":[{"code":"Px00096310046","type":"CDM"},{"code":"00534","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00540 ANESTH CHEST SURGERY","code_information":[{"code":"Px00096310047","type":"CDM"},{"code":"00540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1994.72,"discounted_cash":1496.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00541 ANESTH ONE LUNG VENTILATION","code_information":[{"code":"Px00096310048","type":"CDM"},{"code":"00541","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.08,"discounted_cash":1873.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00542 ANESTH RELEASE OF LUNG","code_information":[{"code":"Px00096310049","type":"CDM"},{"code":"00542","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.08,"discounted_cash":1873.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00546 ANESTH LUNG CHEST WALL SURG","code_information":[{"code":"Px00096310050","type":"CDM"},{"code":"00546","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.08,"discounted_cash":1873.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00548 ANESTH TRACHEA BRONCHI SURG","code_information":[{"code":"Px00096310051","type":"CDM"},{"code":"00548","type":"HCPCS"}],"standard_charges":[{"gross_charge":2831.92,"discounted_cash":2123.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00630 ANESTH LUMBAR REGION NOS","code_information":[{"code":"Px00096310052","type":"CDM"},{"code":"00630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00635 ANESTH LUMBAR PUNCTURE","code_information":[{"code":"Px00096310053","type":"CDM"},{"code":"00635","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00640 ANESTH SPINE MANIPULATION","code_information":[{"code":"Px00096310054","type":"CDM"},{"code":"00640","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00700 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310055","type":"CDM"},{"code":"00700","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00730 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310057","type":"CDM"},{"code":"00730","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.84,"discounted_cash":484.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00750 ANESTH REPAIR OF UPPER HERNIA","code_information":[{"code":"Px00096310059","type":"CDM"},{"code":"00750","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00752 ANESTH REPAIR OF HERNIA VENTRIL &INCISION","code_information":[{"code":"Px00096310060","type":"CDM"},{"code":"00752","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00756 ANESTH REPAIR OF HERNIA UPPER ABD TRANSABD OF DIAPH","code_information":[{"code":"Px00096310062","type":"CDM"},{"code":"00756","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00770 ANESTH BLOOD VESSEL REPAIR","code_information":[{"code":"Px00096310063","type":"CDM"},{"code":"00770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.08,"discounted_cash":1873.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00790 ANESTH SURG UPPER ABDOMEN","code_information":[{"code":"Px00096310064","type":"CDM"},{"code":"00790","type":"HCPCS"}],"standard_charges":[{"gross_charge":1041.04,"discounted_cash":780.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00792 ANESTH HEMORR/EXCISE LIVER","code_information":[{"code":"Px00096310065","type":"CDM"},{"code":"00792","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.2,"discounted_cash":1622.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00794 ANESTH PANCREAS REMOVAL","code_information":[{"code":"Px00096310066","type":"CDM"},{"code":"00794","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00797 ANESTH SURGERY FOR OBESITY","code_information":[{"code":"Px00096310067","type":"CDM"},{"code":"00797","type":"HCPCS"}],"standard_charges":[{"gross_charge":1827.28,"discounted_cash":1370.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00800 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310068","type":"CDM"},{"code":"00800","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00802 ANESTH FAT LAYER REMOVAL","code_information":[{"code":"Px00096310069","type":"CDM"},{"code":"00802","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00820 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310071","type":"CDM"},{"code":"00820","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00830 ANESTH REPAIR OF INGUINAL HERNIA","code_information":[{"code":"Px00096310072","type":"CDM"},{"code":"00830","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00832 ANESTH REPAIR OF HERNIA VENTRI&INCISION","code_information":[{"code":"Px00096310073","type":"CDM"},{"code":"00832","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 31551 LARYNGO W/GRFT W/O STNT YOUNGER THAN 1 YEAR","code_information":[{"code":"Px00096310074","type":"CDM"},{"code":"00834","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00840 ANESTH SURG LOWER ABDOMEN","code_information":[{"code":"Px00096310075","type":"CDM"},{"code":"00840","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.28,"discounted_cash":648.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00844 ANESTH PELVIS SURGERY","code_information":[{"code":"Px00096310076","type":"CDM"},{"code":"00844","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00846 ANESTH HYSTERECTOMY","code_information":[{"code":"Px00096310077","type":"CDM"},{"code":"00846","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00848 ANESTH PELVIC ORGAN SURG","code_information":[{"code":"Px00096310078","type":"CDM"},{"code":"00848","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00851 ANESTH TUBAL LIGATION","code_information":[{"code":"Px00096310079","type":"CDM"},{"code":"00851","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00860 ANESTH SURGERY OF ABDOMEN","code_information":[{"code":"Px00096310080","type":"CDM"},{"code":"00860","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00862 ANESTH KIDNEY/URETER SURG","code_information":[{"code":"Px00096310081","type":"CDM"},{"code":"00862","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00864 ANESTH REMOVAL OF BLADDER","code_information":[{"code":"Px00096310082","type":"CDM"},{"code":"00864","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00865 ANESTH REMOVAL OF PROSTATE","code_information":[{"code":"Px00096310083","type":"CDM"},{"code":"00865","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00866 ANESTH REMOVAL OF ADRENAL","code_information":[{"code":"Px00096310084","type":"CDM"},{"code":"00866","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.88,"discounted_cash":1245.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00870 ANESTH BLADDER STONE SURG","code_information":[{"code":"Px00096310085","type":"CDM"},{"code":"00870","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.84,"discounted_cash":484.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00872 ANESTH KIDNEY STONE DESTRUCT WITH BATH","code_information":[{"code":"Px00096310086","type":"CDM"},{"code":"00872","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00873 ANESTH KIDNEY STONE DESTRUCT-LITHOTRIPSY","code_information":[{"code":"Px00096310087","type":"CDM"},{"code":"00873","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00880 ANESTH ABDOMEN VESSEL SURG","code_information":[{"code":"Px00096310088","type":"CDM"},{"code":"00880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.08,"discounted_cash":1873.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00902 ANESTH ANORECTAL SURGERY","code_information":[{"code":"Px00096310089","type":"CDM"},{"code":"00902","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00904 ANESTH PERINEAL SURGERY","code_information":[{"code":"Px00096310090","type":"CDM"},{"code":"00904","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00906 ANESTH REMOVAL OF VULVA","code_information":[{"code":"Px00096310091","type":"CDM"},{"code":"00906","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00908 ANESTH REMOVAL OF PROSTATE","code_information":[{"code":"Px00096310092","type":"CDM"},{"code":"00908","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00910 ANESTH BLADDER SURGERY","code_information":[{"code":"Px00096310093","type":"CDM"},{"code":"00910","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00912 ANESTH BLADDER TUMOR SURG","code_information":[{"code":"Px00096310094","type":"CDM"},{"code":"00912","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00914 ANESTH REMOVAL OF PROSTATE","code_information":[{"code":"Px00096310095","type":"CDM"},{"code":"00914","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00916 ANESTH BLEEDING CONTROL","code_information":[{"code":"Px00096310096","type":"CDM"},{"code":"00916","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00918 ANESTH STONE REMOVAL","code_information":[{"code":"Px00096310097","type":"CDM"},{"code":"00918","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00920 ANESTH GENITALIA SURGERY","code_information":[{"code":"Px00096310098","type":"CDM"},{"code":"00920","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00924 ANESTH TESTIS EXPLORATION","code_information":[{"code":"Px00096310099","type":"CDM"},{"code":"00924","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00926 ANESTH REMOVAL OF TESTIS INGUINAL","code_information":[{"code":"Px00096310100","type":"CDM"},{"code":"00926","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00930 ANESTH TESTIS SUSPENSION","code_information":[{"code":"Px00096310102","type":"CDM"},{"code":"00930","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00938 ANESTH INSERT PENIS DEVICE","code_information":[{"code":"Px00096310103","type":"CDM"},{"code":"00938","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00940 ANESTH VAGINAL PROCEDURES","code_information":[{"code":"Px00096310104","type":"CDM"},{"code":"00940","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00942 ANESTH SURG ON VAG/URETHRAL","code_information":[{"code":"Px00096310105","type":"CDM"},{"code":"00942","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00944 ANESTH VAGINAL HYSTERECTOMY","code_information":[{"code":"Px00096310106","type":"CDM"},{"code":"00944","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00948 ANESTH REPAIR OF CERVIX","code_information":[{"code":"Px00096310107","type":"CDM"},{"code":"00948","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00950 ANESTH VAGINAL ENDOSCOPY","code_information":[{"code":"Px00096310108","type":"CDM"},{"code":"00950","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00952 ANESTH HYSTEROSCOPE/GRAPH","code_information":[{"code":"Px00096310109","type":"CDM"},{"code":"00952","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01112 ANESTH BONE ASPIRATE/BX","code_information":[{"code":"Px00096310110","type":"CDM"},{"code":"01112","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01120 ANESTH PELVIS SURGERY","code_information":[{"code":"Px00096310111","type":"CDM"},{"code":"01120","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01200 ANESTH HIP JOINT PROCEDURE","code_information":[{"code":"Px00096310112","type":"CDM"},{"code":"01200","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01202 ANESTH ARTHROSCOPY OF HIP","code_information":[{"code":"Px00096310113","type":"CDM"},{"code":"01202","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.84,"discounted_cash":386.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01210 ANESTH HIP JOINT SURGERY","code_information":[{"code":"Px00096310114","type":"CDM"},{"code":"01210","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01212 ANESTH HIP DISARTICULATION","code_information":[{"code":"Px00096310115","type":"CDM"},{"code":"01212","type":"HCPCS"}],"standard_charges":[{"gross_charge":1309.36,"discounted_cash":982.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01214 ANESTH HIP ARTHROPLASTY","code_information":[{"code":"Px00096310116","type":"CDM"},{"code":"01214","type":"HCPCS"}],"standard_charges":[{"gross_charge":1214.72,"discounted_cash":911.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01215 ANESTH REVISE HIP REPAIR","code_information":[{"code":"Px00096310117","type":"CDM"},{"code":"01215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.88,"discounted_cash":1245.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01220 ANESTH PROCEDURE ON FEMUR","code_information":[{"code":"Px00096310118","type":"CDM"},{"code":"01220","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01230 ANESTH SURGERY OF FEMUR","code_information":[{"code":"Px00096310119","type":"CDM"},{"code":"01230","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01232 ANESTH AMPUTATION OF FEMUR","code_information":[{"code":"Px00096310120","type":"CDM"},{"code":"01232","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01250 ANESTH UPPER LEG SURGERY","code_information":[{"code":"Px00096310122","type":"CDM"},{"code":"01250","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01260 ANESTH UPPER LEG VEINS SURG","code_information":[{"code":"Px00096310123","type":"CDM"},{"code":"01260","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01270 ANESTH THIGH ARTERIES SURG","code_information":[{"code":"Px00096310124","type":"CDM"},{"code":"01270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01320 ANESTH KNEE AREA SURGERY","code_information":[{"code":"Px00096310127","type":"CDM"},{"code":"01320","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01340 ANESTH KNEE AREA PROCEDURE","code_information":[{"code":"Px00096310128","type":"CDM"},{"code":"01340","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01360 ANESTH KNEE AREA SURGERY","code_information":[{"code":"Px00096310129","type":"CDM"},{"code":"01360","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01380 ANESTH KNEE JOINT PROCEDURE","code_information":[{"code":"Px00096310130","type":"CDM"},{"code":"01380","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01382 ANESTH DX KNEE ARTHROSCOPY","code_information":[{"code":"Px00096310131","type":"CDM"},{"code":"01382","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01390 ANESTH KNEE AREA PROCEDURE","code_information":[{"code":"Px00096310132","type":"CDM"},{"code":"01390","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01392 ANESTH KNEE AREA SURGERY TIB/FIB/UPPER","code_information":[{"code":"Px00096310133","type":"CDM"},{"code":"01392","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01400 ANESTH KNEE AREA SURGERY ARTHROSCOPY","code_information":[{"code":"Px00096310134","type":"CDM"},{"code":"01400","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01402 ANESTH TOTAL KNEE ARTHROPLASTY","code_information":[{"code":"Px00096310135","type":"CDM"},{"code":"01402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1214.72,"discounted_cash":911.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01404 ANESTH AMPUTATION AT KNEE","code_information":[{"code":"Px00096310136","type":"CDM"},{"code":"01404","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.84,"discounted_cash":484.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01430 ANESTH KNEE VEINS SURGERY","code_information":[{"code":"Px00096310138","type":"CDM"},{"code":"01430","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01462 ANESTH LOWER LEG PROCEDURE","code_information":[{"code":"Px00096310142","type":"CDM"},{"code":"01462","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01464 ANESTH ANKLE/FT ARTHROSCOPY","code_information":[{"code":"Px00096310143","type":"CDM"},{"code":"01464","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01470 ANESTH LOWER LEG SURGERY","code_information":[{"code":"Px00096310144","type":"CDM"},{"code":"01470","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01472 ANESTH ACHILLES TENDON SURG","code_information":[{"code":"Px00096310145","type":"CDM"},{"code":"01472","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01474 ANESTH LOWER LEG SURGERY","code_information":[{"code":"Px00096310146","type":"CDM"},{"code":"01474","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01480 ANESTH LOWER LEG BONE SURG","code_information":[{"code":"Px00096310147","type":"CDM"},{"code":"01480","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.28,"discounted_cash":648.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01482 ANESTH RADICAL LEG SURGERY","code_information":[{"code":"Px00096310148","type":"CDM"},{"code":"01482","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01484 ANESTH LOWER LEG REVISION","code_information":[{"code":"Px00096310149","type":"CDM"},{"code":"01484","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01486 ANESTH ANKLE REPLACEMENT","code_information":[{"code":"Px00096310150","type":"CDM"},{"code":"01486","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01490 ANESTH LOWER LEG CASTING","code_information":[{"code":"Px00096310151","type":"CDM"},{"code":"01490","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01500 ANESTH LEG ARTERIES SURG","code_information":[{"code":"Px00096310152","type":"CDM"},{"code":"01500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01502 ANESTH LWR LEG EMBOLECTOMY","code_information":[{"code":"Px00096310153","type":"CDM"},{"code":"01502","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01520 ANESTH LOWER LEG VEIN SURG","code_information":[{"code":"Px00096310154","type":"CDM"},{"code":"01520","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01522 ANESTH LOWER LEG VEIN SURG-THROMBECTOMY","code_information":[{"code":"Px00096310155","type":"CDM"},{"code":"01522","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01610 ANESTH SURGERY OF SHOULDER AND AXILLA","code_information":[{"code":"Px00096310156","type":"CDM"},{"code":"01610","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01620 ANESTH SHOULDER PROCEDURE","code_information":[{"code":"Px00096310157","type":"CDM"},{"code":"01620","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01622 ANES DX SHOULDER ARTHROSCOPY","code_information":[{"code":"Px00096310158","type":"CDM"},{"code":"01622","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01630 ANESTH SURGERY OF SHOULDER OPEN OR SURGICAL ARTHRO","code_information":[{"code":"Px00096310159","type":"CDM"},{"code":"01630","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01638 ANESTH SHOULDER REPLACEMENT","code_information":[{"code":"Px00096310161","type":"CDM"},{"code":"01638","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.88,"discounted_cash":1245.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01710 ANESTH ELBOW AREA SURGERY","code_information":[{"code":"Px00096310165","type":"CDM"},{"code":"01710","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01712 ANESTH UPPR ARM TENDON OPEN SURG","code_information":[{"code":"Px00096310166","type":"CDM"},{"code":"01712","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.6,"discounted_cash":616.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01714 ANESTH UPPR ARM TENOPLASTY","code_information":[{"code":"Px00096310167","type":"CDM"},{"code":"01714","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.08,"discounted_cash":489.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01716 ANESTH BICEPS TENDON REPAIR","code_information":[{"code":"Px00096310168","type":"CDM"},{"code":"01716","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01730 ANESTH UPPR ARM PROCEDURE","code_information":[{"code":"Px00096310169","type":"CDM"},{"code":"01730","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01732 ANESTH DX ELBOW ARTHROSCOPY","code_information":[{"code":"Px00096310170","type":"CDM"},{"code":"01732","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01740 ANESTH UPPER ARM SURGERY","code_information":[{"code":"Px00096310171","type":"CDM"},{"code":"01740","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01742 ANESTH HUMERUS SURGERY","code_information":[{"code":"Px00096310172","type":"CDM"},{"code":"01742","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01744 ANESTH HUMERUS REPAIR","code_information":[{"code":"Px00096310173","type":"CDM"},{"code":"01744","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01760 ANESTH ELBOW REPLACEMENT","code_information":[{"code":"Px00096310175","type":"CDM"},{"code":"01760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01770 ANESTH UPPR ARM ARTERY SURG","code_information":[{"code":"Px00096310176","type":"CDM"},{"code":"01770","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01772 ANESTH UPPR ARM EMBOLECTOMY","code_information":[{"code":"Px00096310177","type":"CDM"},{"code":"01772","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01780 ANESTH UPPER ARM VEIN SURG","code_information":[{"code":"Px00096310178","type":"CDM"},{"code":"01780","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01810 ANESTH LOWER ARM SURGERY","code_information":[{"code":"Px00096310179","type":"CDM"},{"code":"01810","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01820 ANESTH LOWER ARM PROCEDURE","code_information":[{"code":"Px00096310180","type":"CDM"},{"code":"01820","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01830 ANESTH LOWER ARM SURGERY","code_information":[{"code":"Px00096310182","type":"CDM"},{"code":"01830","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01832 ANESTH WRIST REPLACEMENT","code_information":[{"code":"Px00096310183","type":"CDM"},{"code":"01832","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.92,"discounted_cash":290.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01840 ANESTH LWR ARM ARTERY SURG","code_information":[{"code":"Px00096310184","type":"CDM"},{"code":"01840","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01844 ANESTH VASCULAR SHUNT SURG","code_information":[{"code":"Px00096310186","type":"CDM"},{"code":"01844","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.12,"discounted_cash":743.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01850 ANESTH LOWER ARM VEIN SURG","code_information":[{"code":"Px00096310187","type":"CDM"},{"code":"01850","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01860 ANESTH LOWER ARM CASTING","code_information":[{"code":"Px00096310188","type":"CDM"},{"code":"01860","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.92,"discounted_cash":290.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01916 ANESTH DX ARTERIOGRAPHY","code_information":[{"code":"Px00096310189","type":"CDM"},{"code":"01916","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01922 ANESTH CAT OR MRI SCAN","code_information":[{"code":"Px00096310190","type":"CDM"},{"code":"01922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01958 ANESTH ANTEPARTUM MANIPUL","code_information":[{"code":"Px00096310193","type":"CDM"},{"code":"01958","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01960 ANESTH VAGINAL DELIVERY","code_information":[{"code":"Px00096310194","type":"CDM"},{"code":"01960","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01961 ANESTH CS DELIVERY","code_information":[{"code":"Px00096310195","type":"CDM"},{"code":"01961","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.76,"discounted_cash":385.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01962 ANESTH EMER HYSTERECTOMY","code_information":[{"code":"Px00096310196","type":"CDM"},{"code":"01962","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01963 ANESTH CS HYSTERECTOMY","code_information":[{"code":"Px00096310197","type":"CDM"},{"code":"01963","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.88,"discounted_cash":1245.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01965 ANESTH INC/MISSED AB PROC","code_information":[{"code":"Px00096310198","type":"CDM"},{"code":"01965","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01967 ANESTH/ANALG VAG DELIVERY","code_information":[{"code":"Px00096310199","type":"CDM"},{"code":"01967","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.48,"discounted_cash":516.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01968 ANES/ANALG CS DELIVER ADD-ON","code_information":[{"code":"Px00096310200","type":"CDM"},{"code":"01968","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.4,"discounted_cash":241.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01969 ANESTH/ANALG CS HYST ADD-ON","code_information":[{"code":"Px00096310201","type":"CDM"},{"code":"01969","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01990 SUPPORT FOR ORGAN DONOR","code_information":[{"code":"Px00096310202","type":"CDM"},{"code":"01990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.56,"discounted_cash":868.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01991 ANESTH NERVE BLOCK/INJ","code_information":[{"code":"Px00096310203","type":"CDM"},{"code":"01991","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.92,"discounted_cash":290.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01992 ANESTH N BLOCK/INJ PRONE","code_information":[{"code":"Px00096310204","type":"CDM"},{"code":"01992","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.64,"discounted_cash":616.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01999 UNLISTED ANESTH PROCEDURE","code_information":[{"code":"Px00096310206","type":"CDM"},{"code":"01999","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.84,"discounted_cash":367.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99100 SPECIAL ANESTHESIA SERVICE","code_information":[{"code":"Px00096310207","type":"CDM"},{"code":"99100","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64450 NERVE BLOCK OTHER PERIPHERAL SEPARATE PROC","code_information":[{"code":"Px00096310215","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 62273 INJECT EPIDURAL PATCH","code_information":[{"code":"Px00096310216","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 31500 INTUBATION W/BRONCHOSCOPE","code_information":[{"code":"Px00096310220","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36620 ANES/ARTERIAL CATH/CANNULA","code_information":[{"code":"Px00096310223","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":123.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 62270 ANES/SPINAL PUNC","code_information":[{"code":"Px00096310224","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64425 ANES ILIOINGUINAL NERVE","code_information":[{"code":"Px00096310226","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36556 INSERT NON-TUNNEL CV CATH > 5","code_information":[{"code":"Px00096310231","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36569 INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00096310232","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36410 NON-ROUTINE BL DRAW > 3 YRS","code_information":[{"code":"Px00096310233","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 01966 ANESTH INDUCED AB PROCEDURE","code_information":[{"code":"Px00096310235","type":"CDM"},{"code":"01966","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.44,"discounted_cash":496.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00932 ANESTH AMPUTATION OF PENIS","code_information":[{"code":"Px00096310236","type":"CDM"},{"code":"00932","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.44,"discounted_cash":496.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64447 INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM","code_information":[{"code":"Px00096310238","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":182.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36584 COMPLETE REPLACEMENT PICC RS&I","code_information":[{"code":"Px00096310242","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":167.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64415 INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN CDM","code_information":[{"code":"Px00096310243","type":"CDM"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00560 ANES/HEART PERI SAC WO/PUMP","code_information":[{"code":"Px00096310244","type":"CDM"},{"code":"00560","type":"HCPCS"}],"standard_charges":[{"gross_charge":2522.0,"discounted_cash":1891.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64417 INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN CDM","code_information":[{"code":"Px00096310254","type":"CDM"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64445 INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM","code_information":[{"code":"Px00096310256","type":"CDM"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00731 ANES UPPR GI NDSC PX NOS","code_information":[{"code":"Px00096310282","type":"CDM"},{"code":"00731","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.08,"discounted_cash":489.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00732 ANES UPR GI NDSC PX ERCP","code_information":[{"code":"Px00096310283","type":"CDM"},{"code":"00732","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.08,"discounted_cash":586.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00811 ANES LWR INTST NDSC NOS","code_information":[{"code":"Px00096310284","type":"CDM"},{"code":"00811","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.04,"discounted_cash":390.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00812 ANES LWR INTST SCR COLSC","code_information":[{"code":"Px00096310285","type":"CDM"},{"code":"00812","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.04,"discounted_cash":293.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 00813 ANES UPPR LWR GI NDSC PX","code_information":[{"code":"Px00096310286","type":"CDM"},{"code":"00813","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.08,"discounted_cash":489.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"},{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64999 NERVE BLOCK INJ CERVICAL PLEXUS CDM","code_information":[{"code":"Px00096310287","type":"CDM"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR SYNCH AUDIO-ONLY EST LOW 20 CDM","code_information":[{"code":"Px00096900017","type":"CDM"},{"code":"98013","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99075 MEDICAL TESTIMONY","code_information":[{"code":"Px00096910001","type":"CDM"},{"code":"99075","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96110 DEVELOPMENTAL TEST LIM","code_information":[{"code":"Px00096910005","type":"CDM"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 97605 NEG PRESSURE WOUND THERAPY UTILIZING DME 50 SQ CM OR","code_information":[{"code":"Px00096910007","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":166.0,"discounted_cash":124.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":93.0,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93015 CARDIO STRESS TESTSUPV INTERP & REPT","code_information":[{"code":"Px00096910011","type":"CDM"},{"code":"93015","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PRHOLTER MONITOR W/INTERP & REPT","code_information":[{"code":"Px00096910012","type":"CDM"},{"code":"93224","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":315.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 81025 URINE PREGNANCY TEST","code_information":[{"code":"Px00096910019","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 82962 GLUCOSE BLOOD TEST","code_information":[{"code":"Px00096910020","type":"CDM"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":24.0,"discounted_cash":18.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER","code_information":[{"code":"Px00096910021","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 87880 RAPID STREP SCREEN","code_information":[{"code":"Px00096910025","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 86580 SKIN TEST TUBERCULOSIS INTRADERMAL","code_information":[{"code":"Px00096910026","type":"CDM"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":38.0,"discounted_cash":28.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":38.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 92612 ENDOSCOPY SWALLOW TST (FEES)","code_information":[{"code":"Px00096910056","type":"CDM"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":573.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":765.0,"discounted_cash":573.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 99304 INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN CDM","code_information":[{"code":"Px00096910101","type":"CDM"},{"code":"99304","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":230.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99305 INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES CDM","code_information":[{"code":"Px00096910102","type":"CDM"},{"code":"99305","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":381.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99306 INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES","code_information":[{"code":"Px00096910103","type":"CDM"},{"code":"99306","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.0,"discounted_cash":520.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":694.0,"discounted_cash":520.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":694.0,"discounted_cash":520.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99307 SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES CDM","code_information":[{"code":"Px00096910104","type":"CDM"},{"code":"99307","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99308 SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES","code_information":[{"code":"Px00096910105","type":"CDM"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":284.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99309 SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES CDM","code_information":[{"code":"Px00096910106","type":"CDM"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":309.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":412.0,"discounted_cash":309.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":412.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99310 SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES CDM","code_information":[{"code":"Px00096910107","type":"CDM"},{"code":"99310","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":441.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":588.0,"discounted_cash":441.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":588.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99315 NURSING FACILITY DISCHARGE MGMT 30 MINS/OR LESS TOTAL CDM","code_information":[{"code":"Px00096910108","type":"CDM"},{"code":"99315","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":233.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":311.0,"discounted_cash":233.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":311.0,"discounted_cash":233.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99316 NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME CDM","code_information":[{"code":"Px00096910109","type":"CDM"},{"code":"99316","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":498.0,"discounted_cash":373.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99342 HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES CDM","code_information":[{"code":"Px00096910118","type":"CDM"},{"code":"99342","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99347 HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES CDM","code_information":[{"code":"Px00096910122","type":"CDM"},{"code":"99347","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":129.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99348 HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES CDM","code_information":[{"code":"Px00096910123","type":"CDM"},{"code":"99348","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":219.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99349 HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES CDM","code_information":[{"code":"Px00096910124","type":"CDM"},{"code":"99349","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":363.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":485.0,"discounted_cash":363.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99350 HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES CDM","code_information":[{"code":"Px00096910125","type":"CDM"},{"code":"99350","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99381 INITIAL PREVENTIVE MEDICINE NEW PATIENT/YOUNGER THAN 1 YR","code_information":[{"code":"Px00096910144","type":"CDM"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99382 INIT PM E/M NEW PAT 1-4 YRS","code_information":[{"code":"Px00096910147","type":"CDM"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99383 PREV VISIT NEW AGE 5-11","code_information":[{"code":"Px00096910149","type":"CDM"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99384 PREV VISIT NEW AGE 12-17","code_information":[{"code":"Px00096910152","type":"CDM"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99385 PREV VISIT NEW AGE 18-39","code_information":[{"code":"Px00096910154","type":"CDM"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":268.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99386 PREV VISIT NEW AGE 40-64","code_information":[{"code":"Px00096910156","type":"CDM"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99387 INIT PM E/M NEW PAT 65+ YRS","code_information":[{"code":"Px00096910158","type":"CDM"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99391 PER PM REEVAL EST PAT INF","code_information":[{"code":"Px00096910161","type":"CDM"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":189.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99392 PREV VISIT EST AGE 1-4","code_information":[{"code":"Px00096910163","type":"CDM"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99393 PREV VISIT EST AGE 5-11","code_information":[{"code":"Px00096910165","type":"CDM"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99394 PREV VISIT EST AGE 12-17","code_information":[{"code":"Px00096910167","type":"CDM"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99395 PREV VISIT EST AGE 18-39","code_information":[{"code":"Px00096910170","type":"CDM"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":338.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":451.0,"discounted_cash":338.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":328.0,"discounted_cash":246.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99396 PREV VISIT EST AGE 40-64","code_information":[{"code":"Px00096910172","type":"CDM"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36415 ROUTINE VENIPUNCTURE","code_information":[{"code":"Px00096910173","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99397 PER PM REEVAL EST PAT 65+ YR","code_information":[{"code":"Px00096910174","type":"CDM"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99402 PREVENTIVE COUNSELING INDIV 30 MIN","code_information":[{"code":"Px00096910178","type":"CDM"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99404 PREVENTIVE COUNSELING INDIV 60 MIN","code_information":[{"code":"Px00096910182","type":"CDM"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":273.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44204 LAPAROSCOPY PARTIAL COLECTOMY","code_information":[{"code":"Px00096910214","type":"CDM"},{"code":"44204","type":"HCPCS"}],"standard_charges":[{"gross_charge":5888.0,"discounted_cash":4416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44205 LAPAROSCOPY COLECTOMY PART W/ILEUM","code_information":[{"code":"Px00096910215","type":"CDM"},{"code":"44205","type":"HCPCS"}],"standard_charges":[{"gross_charge":5114.0,"discounted_cash":3835.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46080 INCISION OF ANAL SPHINCTER","code_information":[{"code":"Px00096910217","type":"CDM"},{"code":"46080","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":460.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 49500 REPAIR INGUINAL HERNIA INITIAL REDUCIBLE","code_information":[{"code":"Px00096910219","type":"CDM"},{"code":"49500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":1221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49520 REREPAIR INGUINAL HERNIA REDUCE","code_information":[{"code":"Px00096910221","type":"CDM"},{"code":"49520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2464.0,"discounted_cash":1848.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2464.0,"discounted_cash":1848.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2464.0,"discounted_cash":1848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49521 REREPAIR INGUINAL HERNIA BLOCKED","code_information":[{"code":"Px00096910222","type":"CDM"},{"code":"49521","type":"HCPCS"}],"standard_charges":[{"gross_charge":2790.0,"discounted_cash":2092.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2790.0,"discounted_cash":2092.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49525 REPAIR INGUINAL HERNIA SLIDING","code_information":[{"code":"Px00096910223","type":"CDM"},{"code":"49525","type":"HCPCS"}],"standard_charges":[{"gross_charge":2239.0,"discounted_cash":1679.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51040 CYSTOSTOMY CYSTOTOMY W DRAINAGE CDM","code_information":[{"code":"Px00096910236","type":"CDM"},{"code":"51040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":850.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51705 CHANGE CYSTOSTOMY TUBE SIMPLE","code_information":[{"code":"Px00096910238","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":200.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":201.0,"discounted_cash":150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51720 TREATMENT OF BLADDER LESION","code_information":[{"code":"Px00096910239","type":"CDM"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52000 CYSTOURETHROSCOPY","code_information":[{"code":"Px00096910242","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":633.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":306.0,"discounted_cash":229.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52234 CYSTOCSCOPY AND TREATMENT SMALL TUMOR, 0.5 - 2.0CM","code_information":[{"code":"Px00096910247","type":"CDM"},{"code":"52234","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":700.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52240 CYSTOSCOPY AND TREATMENT LARGE TUMOR, >5.0CM","code_information":[{"code":"Px00096910249","type":"CDM"},{"code":"52240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.0,"discounted_cash":1113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52281 CYSTOSCOPY AND TREATMENT STRICTURE/DILATION","code_information":[{"code":"Px00096910252","type":"CDM"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":435.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52310 CYSTOURETHROSCOPY, WITHFB REMOVAL SIMPLE","code_information":[{"code":"Px00096910258","type":"CDM"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":434.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52601 PROSTATECTOMY (TURP)","code_information":[{"code":"Px00096910273","type":"CDM"},{"code":"52601","type":"HCPCS"}],"standard_charges":[{"gross_charge":2798.0,"discounted_cash":2098.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52630 REMOVE PROSTATE REGROWTH","code_information":[{"code":"Px00096910274","type":"CDM"},{"code":"52630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"discounted_cash":1182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 54056 CRYOSURGERY PENIS LESION(S)","code_information":[{"code":"Px00096910299","type":"CDM"},{"code":"54056","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":424.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":566.0,"discounted_cash":424.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":440.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0402 INITIAL PREVENTIVE EXAM MC","code_information":[{"code":"Px00096910316","type":"CDM"},{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":477.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":636.0,"discounted_cash":477.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":498.0,"discounted_cash":373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 76801 US OB/LESS THAN 14 WKS/SINGLE FETUS OR 1ST GEST","code_information":[{"code":"Px00096910317","type":"CDM"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":335.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76802 US OB/LESS THAN 14 WKS/ADDL FETUS","code_information":[{"code":"Px00096910318","type":"CDM"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":171.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":229.0,"discounted_cash":171.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 76815 US OB LIMITED FETUS(S)","code_information":[{"code":"Px00096910319","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":232.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76817 US OB TRANSVAGINAL","code_information":[{"code":"Px00096910320","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":264.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76819 US FETAL BIOPHYS PROFILE W/O NST","code_information":[{"code":"Px00096910321","type":"CDM"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":246.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":329.0,"discounted_cash":246.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 91010 ESOPHAGEAL MANOMETRY","code_information":[{"code":"Px00096910324","type":"CDM"},{"code":"91010","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":621.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":828.0,"discounted_cash":621.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 91035 G-ESOPH REFLX TST W/ELECTROD","code_information":[{"code":"Px00096910327","type":"CDM"},{"code":"91035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.0,"discounted_cash":1258.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1678.0,"discounted_cash":1258.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 92551 PURE TONE HEARING TEST AIR","code_information":[{"code":"Px00096910331","type":"CDM"},{"code":"92551","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90473 VFC IMMUNE ADMIN ORAL/NASAL INITIAL","code_information":[{"code":"Px00096910340","type":"CDM"},{"code":"90473","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90474 VFC IMMUNE ADMIN ORAL/NASAL ADDL","code_information":[{"code":"Px00096910341","type":"CDM"},{"code":"90474","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0009 MEDICARE ADMIN PNEUMOCOCCAL VACCINE","code_information":[{"code":"Px00096910344","type":"CDM"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 64708 HC PR NEUROPLASTY OTHER ARM/LEG NERVE,OPEN","code_information":[{"code":"Px00096910345","type":"CDM"},{"code":"64708","type":"HCPCS"}],"standard_charges":[{"gross_charge":1985.0,"discounted_cash":1488.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26111 EXC TUM HAND/FGR >1.5 CM","code_information":[{"code":"Px00096910357","type":"CDM"},{"code":"26111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":1233.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32550 INDWELL TUNN PLEURL CATH","code_information":[{"code":"Px00096910358","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":2844.0,"discounted_cash":2133.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2844.0,"discounted_cash":2133.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 93279 PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP","code_information":[{"code":"Px00096910359","type":"CDM"},{"code":"93279","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":255.0,"discounted_cash":191.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93280 PM DEV PROGR EVAL DUAL","code_information":[{"code":"Px00096910360","type":"CDM"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93281 MLTPL LEAD PM PROG EVAL","code_information":[{"code":"Px00096910361","type":"CDM"},{"code":"93281","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":237.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":316.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93282 PRGRMG EVAL SINGLE IMPLANTABLE DFB","code_information":[{"code":"Px00096910362","type":"CDM"},{"code":"93282","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":225.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":301.0,"discounted_cash":225.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":301.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93283 PRGRMG EVAL DUAL IMPLANTABLE DFB","code_information":[{"code":"Px00096910363","type":"CDM"},{"code":"93283","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":277.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":370.0,"discounted_cash":277.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":370.0,"discounted_cash":277.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93284 PRGRMG EVAL MULT IMPLANTABLE DFB","code_information":[{"code":"Px00096910364","type":"CDM"},{"code":"93284","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":299.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":399.0,"discounted_cash":299.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":399.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93294 REM INTERROG PM/LDLS PM LTE 90 DAYS PHYS/QHP","code_information":[{"code":"Px00096910365","type":"CDM"},{"code":"93294","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93295 INTER DEV DEFB RMT 90DYS","code_information":[{"code":"Px00096910366","type":"CDM"},{"code":"93295","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":102.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR Q4036 CAST CLUBFOOT PEDS FIBERGL","code_information":[{"code":"Px00096910379","type":"CDM"},{"code":"Q4036","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 99395 SPORT PHYSICAL EST AGE 18-39","code_information":[{"code":"Px00096910384","type":"CDM"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25020 DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT CDM","code_information":[{"code":"Px00096910397","type":"CDM"},{"code":"25020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2844.0,"discounted_cash":2133.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR G0101 SCREEN PELVIC/BREAST EXAM","code_information":[{"code":"Px00096910436","type":"CDM"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":104.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR Q0091 OBTAINING SCREEN PAP SMEAR","code_information":[{"code":"Px00096910439","type":"CDM"},{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90882 ENVIRONMENTAL MANIPULATION","code_information":[{"code":"Px00096910452","type":"CDM"},{"code":"90882","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90460 IMMU ADM ANY ROUTE/1ST VAC OR TOX/UP TO 18YRS","code_information":[{"code":"Px00096910461","type":"CDM"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":66.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":88.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 90461 IMMU ADM ANY ROUTE/EA ADDL VAC OR TOX/UP TO 18YRS","code_information":[{"code":"Px00096910462","type":"CDM"},{"code":"90461","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":24.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 95115 IMMUNOTHERAPY ONE INJECTION","code_information":[{"code":"Px00096910465","type":"CDM"},{"code":"95115","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":30.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":41.0,"discounted_cash":30.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":41.0,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 95117 IMMUNOTHERAPY INJECTIONS","code_information":[{"code":"Px00096910466","type":"CDM"},{"code":"95117","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR","code_information":[{"code":"Px00096910468","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":89.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":119.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96361 HYDRATE IV INFUSION EACH ADDL HOUR CDM","code_information":[{"code":"Px00096910469","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96372 THER/PROPH/DIAG INJ SC/IM","code_information":[{"code":"Px00096910474","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":73.0,"discounted_cash":54.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96374 THER/PROPH/DIAG INJ IV PUSH","code_information":[{"code":"Px00096910475","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":134.0,"discounted_cash":100.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 96402 CHEMO HORMON ANTINEOPL SQ/IM","code_information":[{"code":"Px00096910478","type":"CDM"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0010 MEDICARE ADMIN HEPATITIS B VACCINE","code_information":[{"code":"Px00096910483","type":"CDM"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11404 EXC TR-EXT B9+MARG 3.1-4 CM","code_information":[{"code":"Px00096910485","type":"CDM"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":650.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":644.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11406 EXC B9 LESION MRGN XCP SK TG T/A/L GT 4.0 CM CDM","code_information":[{"code":"Px00096910486","type":"CDM"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":925.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":966.0,"discounted_cash":724.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11421 EXC H-F-NK-SP B9+MARG 0.6-1","code_information":[{"code":"Px00096910489","type":"CDM"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":459.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":424.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11424 EXC H-F-NK-SP B9+MARG 3.1-4","code_information":[{"code":"Px00096910490","type":"CDM"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":691.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":708.0,"discounted_cash":531.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11441 EXC FACE-MM B9+MARG 0.6-1 CM","code_information":[{"code":"Px00096910492","type":"CDM"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":499.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":666.0,"discounted_cash":499.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11601 EXC TR-EXT MLG+MARG 0.6-1 CM","code_information":[{"code":"Px00096910495","type":"CDM"},{"code":"11601","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.0,"discounted_cash":657.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 11602 EXC TR-EXT MLG+MARG 1.1-2 CM","code_information":[{"code":"Px00096910496","type":"CDM"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":705.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":941.0,"discounted_cash":705.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":623.0,"discounted_cash":467.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","code_information":[{"code":"Px00096910497","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11721 DEBRIDE NAIL 6 OR MORE","code_information":[{"code":"Px00096910498","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11900 INJECTION INTO SKIN LESIONS","code_information":[{"code":"Px00096910501","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":165.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":220.0,"discounted_cash":165.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":113.0,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11901 ADDED SKIN LESIONS INJECTION","code_information":[{"code":"Px00096910502","type":"CDM"},{"code":"11901","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":129.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17110 DESTRUCT B9 LESION 1-14","code_information":[{"code":"Px00096910506","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":326.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":435.0,"discounted_cash":326.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":268.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17266 DESTRUCTION OF SKIN LESIONS TNK/ARM/LG M >4","code_information":[{"code":"Px00096910510","type":"CDM"},{"code":"17266","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":444.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17340 CRYOTHERAPY OF SKIN","code_information":[{"code":"Px00096910512","type":"CDM"},{"code":"17340","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS","code_information":[{"code":"Px00096910513","type":"CDM"},{"code":"19120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1515.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1633.0,"discounted_cash":1224.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 19125 EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES","code_information":[{"code":"Px00096910514","type":"CDM"},{"code":"19125","type":"HCPCS"}],"standard_charges":[{"gross_charge":2227.0,"discounted_cash":1670.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2227.0,"discounted_cash":1670.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 19301 PARTIAL MASTECTOMY","code_information":[{"code":"Px00096910516","type":"CDM"},{"code":"19301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1920.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2561.0,"discounted_cash":1920.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 19302 P-MASTECTOMY W/LN REMOVAL","code_information":[{"code":"Px00096910517","type":"CDM"},{"code":"19302","type":"HCPCS"}],"standard_charges":[{"gross_charge":3519.0,"discounted_cash":2639.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 19303 MAST SIMPLE COMPLETE","code_information":[{"code":"Px00096910518","type":"CDM"},{"code":"19303","type":"HCPCS"}],"standard_charges":[{"gross_charge":3721.0,"discounted_cash":2790.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3721.0,"discounted_cash":2790.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3721.0,"discounted_cash":2790.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20526 THER INJECTION CARP TUNNEL","code_information":[{"code":"Px00096910519","type":"CDM"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":320.0,"discounted_cash":240.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":219.0,"discounted_cash":164.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 21933 EXC BACK TUM DEEP 5+ CM SUBFACIAL","code_information":[{"code":"Px00096910521","type":"CDM"},{"code":"21933","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":2154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 23071 EXC SHOULDER LES SC > 3 CM","code_information":[{"code":"Px00096910523","type":"CDM"},{"code":"23071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":1236.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 23130 REMOVE SHOULDER BONE PART","code_information":[{"code":"Px00096910525","type":"CDM"},{"code":"23130","type":"HCPCS"}],"standard_charges":[{"gross_charge":2440.0,"discounted_cash":1830.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2440.0,"discounted_cash":1830.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 23472 RECONSTRUCT SHOULDER JOINT ARTHROPLASTY","code_information":[{"code":"Px00096910527","type":"CDM"},{"code":"23472","type":"HCPCS"}],"standard_charges":[{"gross_charge":5599.0,"discounted_cash":4199.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23515 TREAT CLAVICLE FRACTURE","code_information":[{"code":"Px00096910528","type":"CDM"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":2830.0,"discounted_cash":2122.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2830.0,"discounted_cash":2122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24071 EXC ARM/ELBOW LES SC 3+ CM","code_information":[{"code":"Px00096910531","type":"CDM"},{"code":"24071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1591.0,"discounted_cash":1193.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 24101 EXPLORE/TREAT ELBOW JOINT","code_information":[{"code":"Px00096910532","type":"CDM"},{"code":"24101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1994.0,"discounted_cash":1495.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 24105 REMOVAL OF ELBOW BURSA","code_information":[{"code":"Px00096910533","type":"CDM"},{"code":"24105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.0,"discounted_cash":1077.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11603 EXC TR-EXT MLG+MARG 2.1-3 CM","code_information":[{"code":"Px00096910535","type":"CDM"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":804.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":745.0,"discounted_cash":558.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20670 REMOVAL OF SUPPORT IMPLANT","code_information":[{"code":"Px00096910537","type":"CDM"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.0,"discounted_cash":1007.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1343.0,"discounted_cash":1007.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 20680 REMOVAL OF IMPLANT","code_information":[{"code":"Px00096910538","type":"CDM"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.0,"discounted_cash":1730.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2307.0,"discounted_cash":1730.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1638.0,"discounted_cash":1228.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20694 REMOVE BONE FIXATION DEVICE","code_information":[{"code":"Px00096910539","type":"CDM"},{"code":"20694","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.0,"discounted_cash":1263.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1684.0,"discounted_cash":1263.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 94640 NEBULIZER SMALL VOLUME","code_information":[{"code":"Px00096910543","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25028 DRAINAGE OF FOREARM LESION","code_information":[{"code":"Px00096910549","type":"CDM"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.0,"discounted_cash":1995.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2660.0,"discounted_cash":1995.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27536 OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ","code_information":[{"code":"Px00096910550","type":"CDM"},{"code":"27536","type":"HCPCS"}],"standard_charges":[{"gross_charge":4625.0,"discounted_cash":3468.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10030 GUIDE CATH FLUID DRAINAGE SOFT TISSUE","code_information":[{"code":"Px00096910586","type":"CDM"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":383.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59025 FETAL NON-STRESS TEST","code_information":[{"code":"Px00096910601","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":189.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59410 VAG DELIVERY W/POSTPARTUM","code_information":[{"code":"Px00096910609","type":"CDM"},{"code":"59410","type":"HCPCS"}],"standard_charges":[{"gross_charge":4159.0,"discounted_cash":3119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59412 EXTERANAL VERSION","code_information":[{"code":"Px00096910611","type":"CDM"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":297.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":396.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59812 TREATMENT OF MISCARRIAGE","code_information":[{"code":"Px00096910621","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":1048.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 59820 CARE OF MISCARRIAGE","code_information":[{"code":"Px00096910622","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1696.0,"discounted_cash":1272.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1501.0,"discounted_cash":1125.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59821 TREATMENT OF MISCARRIAGE 2ND TRI","code_information":[{"code":"Px00096910623","type":"CDM"},{"code":"59821","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1252.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 59430 POSTPARTUM CARE ONLY","code_information":[{"code":"Px00096910628","type":"CDM"},{"code":"59430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":758.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":686.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59515 CESAREAN DELIVERY W PP CARE","code_information":[{"code":"Px00096910629","type":"CDM"},{"code":"59515","type":"HCPCS"}],"standard_charges":[{"gross_charge":5158.0,"discounted_cash":3868.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":5158.0,"discounted_cash":3868.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99460 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB","code_information":[{"code":"Px00096910630","type":"CDM"},{"code":"99460","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":263.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99462 NEWBORN HOSPITAL VISIT","code_information":[{"code":"Px00096910631","type":"CDM"},{"code":"99462","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99463 NEWBORN DISCHARGE SAME DAY","code_information":[{"code":"Px00096910632","type":"CDM"},{"code":"99463","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99468 NEONATE CRIT CARE INITIAL","code_information":[{"code":"Px00096910635","type":"CDM"},{"code":"99468","type":"HCPCS"}],"standard_charges":[{"gross_charge":3375.0,"discounted_cash":2531.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59514 CESAREAN DELIVERY ONLY","code_information":[{"code":"Px00096910638","type":"CDM"},{"code":"59514","type":"HCPCS"}],"standard_charges":[{"gross_charge":3483.0,"discounted_cash":2612.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR A4562 PESSARY - NON RUBBER - ANY TYPE","code_information":[{"code":"Px00096910644","type":"CDM"},{"code":"A4562","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":83.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":112.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4006 CAST SUP LONG ARM ADULT FBRG","code_information":[{"code":"Px00096910693","type":"CDM"},{"code":"Q4006","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4008 CAST SUP LONG ARM PED FBRGLS","code_information":[{"code":"Px00096910694","type":"CDM"},{"code":"Q4008","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4010 CAST SUP SHT ARM ADULT FBRGL","code_information":[{"code":"Px00096910695","type":"CDM"},{"code":"Q4010","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":36.0,"discounted_cash":27.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR Q4012 CAST SUP SHT ARM PED FBRGLAS","code_information":[{"code":"Px00096910696","type":"CDM"},{"code":"Q4012","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR Q4014 CAST SUP GAUNTLET FIBERGLASS","code_information":[{"code":"Px00096910697","type":"CDM"},{"code":"Q4014","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":28.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4022 CAST SUP SHT ARM SPLINT FBRG","code_information":[{"code":"Px00096910700","type":"CDM"},{"code":"Q4022","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 25000 INCISION OF TENDON SHEATH","code_information":[{"code":"Px00096910705","type":"CDM"},{"code":"25000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.0,"discounted_cash":1035.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25447 ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS CDM","code_information":[{"code":"Px00096910712","type":"CDM"},{"code":"25447","type":"HCPCS"}],"standard_charges":[{"gross_charge":3146.0,"discounted_cash":2359.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3146.0,"discounted_cash":2359.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3146.0,"discounted_cash":2359.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25515 TREAT FRACTURE OF RADIUS","code_information":[{"code":"Px00096910713","type":"CDM"},{"code":"25515","type":"HCPCS"}],"standard_charges":[{"gross_charge":2646.0,"discounted_cash":1984.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 25607 TREAT FX RAD EXTRA-ARTICUL","code_information":[{"code":"Px00096910719","type":"CDM"},{"code":"25607","type":"HCPCS"}],"standard_charges":[{"gross_charge":2927.0,"discounted_cash":2195.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2927.0,"discounted_cash":2195.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25608 TREAT FX RAD INTRA-ARTICUL","code_information":[{"code":"Px00096910720","type":"CDM"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":3260.0,"discounted_cash":2445.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3260.0,"discounted_cash":2445.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3260.0,"discounted_cash":2445.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26055 INCISE FINGER TENDON SHEATH","code_information":[{"code":"Px00096910722","type":"CDM"},{"code":"26055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":1690.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2254.0,"discounted_cash":1690.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1165.0,"discounted_cash":873.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26115 EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ/LESS THAN 1.5CM","code_information":[{"code":"Px00096910726","type":"CDM"},{"code":"26115","type":"HCPCS"}],"standard_charges":[{"gross_charge":2118.0,"discounted_cash":1588.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26121 RELEASE PALM CONTRACTURE ONLY","code_information":[{"code":"Px00096910728","type":"CDM"},{"code":"26121","type":"HCPCS"}],"standard_charges":[{"gross_charge":2371.0,"discounted_cash":1778.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26123 RELEASE PALM CONTRACTURE PARTIAL","code_information":[{"code":"Px00096910729","type":"CDM"},{"code":"26123","type":"HCPCS"}],"standard_charges":[{"gross_charge":3304.0,"discounted_cash":2478.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3304.0,"discounted_cash":2478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26160 REMOVE TENDON SHEATH LESION","code_information":[{"code":"Px00096910731","type":"CDM"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2355.0,"discounted_cash":1766.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1260.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26615 TREAT METACARPAL FRACTURE W/INTERNAL FIXATION","code_information":[{"code":"Px00096910735","type":"CDM"},{"code":"26615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.0,"discounted_cash":1711.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26727 TX FINGER FRACTURE W/PERC FIXATION W/MANIP EACH","code_information":[{"code":"Px00096910738","type":"CDM"},{"code":"26727","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":1416.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1888.0,"discounted_cash":1416.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26735 OPEN TX PHALANGEAL SHAFT FRACTURE FINGER/THUMB W/O MANIP","code_information":[{"code":"Px00096910739","type":"CDM"},{"code":"26735","type":"HCPCS"}],"standard_charges":[{"gross_charge":2355.0,"discounted_cash":1766.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 27130 TOTAL HIP ARTHROPLASTY","code_information":[{"code":"Px00096910747","type":"CDM"},{"code":"27130","type":"HCPCS"}],"standard_charges":[{"gross_charge":4983.0,"discounted_cash":3737.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27132 TOTAL HIP ARTHROPLASTY - REPLCMNT","code_information":[{"code":"Px00096910748","type":"CDM"},{"code":"27132","type":"HCPCS"}],"standard_charges":[{"gross_charge":6470.0,"discounted_cash":4852.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27235 PERC FIXATION THIGH FRACTURE","code_information":[{"code":"Px00096910750","type":"CDM"},{"code":"27235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3539.0,"discounted_cash":2654.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3539.0,"discounted_cash":2654.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27244 TX FEMORAL FRACTURE W/PLATE/SCREW TYPE IMPLANT","code_information":[{"code":"Px00096910751","type":"CDM"},{"code":"27244","type":"HCPCS"}],"standard_charges":[{"gross_charge":4774.0,"discounted_cash":3580.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27245 TX FEMORAL FRACTURE W/INTRAMEDULARY TYPE IMPLANT","code_information":[{"code":"Px00096910752","type":"CDM"},{"code":"27245","type":"HCPCS"}],"standard_charges":[{"gross_charge":4768.0,"discounted_cash":3576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27236 OPEN TX THIGH FRACTURE W/O MANIP","code_information":[{"code":"Px00096910755","type":"CDM"},{"code":"27236","type":"HCPCS"}],"standard_charges":[{"gross_charge":4640.0,"discounted_cash":3480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25609 TREAT FX RADIAL 3+ FRAG","code_information":[{"code":"Px00096910758","type":"CDM"},{"code":"25609","type":"HCPCS"}],"standard_charges":[{"gross_charge":4132.0,"discounted_cash":3099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27337 EXC THIGH/KNEE LES SC 3+ CM","code_information":[{"code":"Px00096910759","type":"CDM"},{"code":"27337","type":"HCPCS"}],"standard_charges":[{"gross_charge":1647.0,"discounted_cash":1235.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 27340 REMOVAL OF KNEECAP BURSA","code_information":[{"code":"Px00096910760","type":"CDM"},{"code":"27340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.0,"discounted_cash":1118.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27385 SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY","code_information":[{"code":"Px00096910761","type":"CDM"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2380.0,"discounted_cash":1785.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2380.0,"discounted_cash":1785.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2380.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27446 REVISION OF KNEE JOINT","code_information":[{"code":"Px00096910763","type":"CDM"},{"code":"27446","type":"HCPCS"}],"standard_charges":[{"gross_charge":4463.0,"discounted_cash":3347.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":4463.0,"discounted_cash":3347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27447 TOTAL KNEE ARTHROPLASTY","code_information":[{"code":"Px00096910764","type":"CDM"},{"code":"27447","type":"HCPCS"}],"standard_charges":[{"gross_charge":4977.0,"discounted_cash":3732.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":4977.0,"discounted_cash":3732.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":4977.0,"discounted_cash":3732.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27506 TREATMENT OF THIGH FX","code_information":[{"code":"Px00096910766","type":"CDM"},{"code":"27506","type":"HCPCS"}],"standard_charges":[{"gross_charge":5204.0,"discounted_cash":3903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27524 TREAT KNEECAP FRACTURE","code_information":[{"code":"Px00096910767","type":"CDM"},{"code":"27524","type":"HCPCS"}],"standard_charges":[{"gross_charge":2956.0,"discounted_cash":2217.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2956.0,"discounted_cash":2217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27532 TREAT KNEE FRACTURE PROXIMAL TIBIAL W/MANIP","code_information":[{"code":"Px00096910768","type":"CDM"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":2464.0,"discounted_cash":1848.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2464.0,"discounted_cash":1848.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 27535 TREAT KNEE FRACTURE","code_information":[{"code":"Px00096910769","type":"CDM"},{"code":"27535","type":"HCPCS"}],"standard_charges":[{"gross_charge":3487.0,"discounted_cash":2615.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27570 FIXATION OF KNEE JOINT","code_information":[{"code":"Px00096910772","type":"CDM"},{"code":"27570","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":458.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":611.0,"discounted_cash":458.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27759 TX TIBIAL SHAFT FRACTURE BY INTERMEDULLARY IMPLANT","code_information":[{"code":"Px00096910778","type":"CDM"},{"code":"27759","type":"HCPCS"}],"standard_charges":[{"gross_charge":3890.0,"discounted_cash":2917.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3890.0,"discounted_cash":2917.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3890.0,"discounted_cash":2917.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27792 TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"Px00096910779","type":"CDM"},{"code":"27792","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.0,"discounted_cash":1892.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2523.0,"discounted_cash":1892.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2523.0,"discounted_cash":1892.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27823 OPEN TREATMENT OF ANKLE FRACTURE W/FIXATION","code_information":[{"code":"Px00096910780","type":"CDM"},{"code":"27823","type":"HCPCS"}],"standard_charges":[{"gross_charge":3826.0,"discounted_cash":2869.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3826.0,"discounted_cash":2869.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3826.0,"discounted_cash":2869.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27825 CLOSED TREAT LOWER LEG FRACTURE W/MANIP","code_information":[{"code":"Px00096910781","type":"CDM"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":2603.0,"discounted_cash":1952.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR 27829 OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT","code_information":[{"code":"Px00096910784","type":"CDM"},{"code":"27829","type":"HCPCS"}],"standard_charges":[{"gross_charge":2752.0,"discounted_cash":2064.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2752.0,"discounted_cash":2064.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2752.0,"discounted_cash":2064.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28820 AMPUTATION OF TOE","code_information":[{"code":"Px00096910798","type":"CDM"},{"code":"28820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1129.0,"discounted_cash":846.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 29085 APPLY HAND/WRIST CAST","code_information":[{"code":"Px00096910800","type":"CDM"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":288.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":265.0,"discounted_cash":198.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 54150 CIRCUMCISION W/REGIONAL BLOCK","code_information":[{"code":"Px00096910802","type":"CDM"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":427.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":367.0,"discounted_cash":275.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 54160 CIRCUMCISION NEONATE","code_information":[{"code":"Px00096910803","type":"CDM"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":419.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 54860 REMOVAL OF EPIDIDYMIS","code_information":[{"code":"Px00096910826","type":"CDM"},{"code":"54860","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57061 DESTROY VAGINAL LESIONS SIMPLE","code_information":[{"code":"Px00096910837","type":"CDM"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":479.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":447.0,"discounted_cash":335.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57120 CLOSURE OF VAGINA","code_information":[{"code":"Px00096910838","type":"CDM"},{"code":"57120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.0,"discounted_cash":1536.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 57160 INSERT PESSARY/OTHER DEVICE","code_information":[{"code":"Px00096910839","type":"CDM"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":285.0,"discounted_cash":213.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":177.0,"discounted_cash":132.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57170 FITTING OF DIAPHRAGM/CAP","code_information":[{"code":"Px00096910840","type":"CDM"},{"code":"57170","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":182.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57500 BIOPSY OF CERVIX","code_information":[{"code":"Px00096910843","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":434.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":291.0,"discounted_cash":218.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57505 ENDOCERVICAL CURETTAGE","code_information":[{"code":"Px00096910844","type":"CDM"},{"code":"57505","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":441.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":422.0,"discounted_cash":316.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57511 CRYOCAUTERY OF CERVIX","code_information":[{"code":"Px00096910845","type":"CDM"},{"code":"57511","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":427.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58100 BIOPSY OF UTERUS LINING","code_information":[{"code":"Px00096910848","type":"CDM"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":288.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":385.0,"discounted_cash":288.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":242.0,"discounted_cash":181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58300 INSERT INTRAUTERINE DEVICE","code_information":[{"code":"Px00096910850","type":"CDM"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":144.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58340 CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"Px00096910851","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":669.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":893.0,"discounted_cash":669.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 51710 CHANGE OF BLADDER TUBE, COMPLICATED","code_information":[{"code":"Px00096910856","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":230.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64718 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW","code_information":[{"code":"Px00096910861","type":"CDM"},{"code":"64718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2381.0,"discounted_cash":1785.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2381.0,"discounted_cash":1785.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64721 CARPAL TUNNEL SURGERY","code_information":[{"code":"Px00096910862","type":"CDM"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.0,"discounted_cash":1317.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1756.0,"discounted_cash":1317.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1727.0,"discounted_cash":1295.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 69220 CLEAN OUT MASTOID CAVITY SIMPLE","code_information":[{"code":"Px00096910865","type":"CDM"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":228.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":305.0,"discounted_cash":228.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR G0168 WOUND CLOSURE BY ADHESIVE","code_information":[{"code":"Px00096910867","type":"CDM"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24665 OPEN TX RADIUS HD FRACTURE","code_information":[{"code":"Px00096910869","type":"CDM"},{"code":"24665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2598.0,"discounted_cash":1948.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 29435 APPLY SHORT LEG CAST","code_information":[{"code":"Px00096910872","type":"CDM"},{"code":"29435","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":253.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29710 REMOVAL/REVISION OF CAST","code_information":[{"code":"Px00096910874","type":"CDM"},{"code":"29710","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29822 SHOULDER ARTHROSCOPY/SURGERY DEBRIDEMENT","code_information":[{"code":"Px00096910877","type":"CDM"},{"code":"29822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1599.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 29827 ARTHROSCOP ROTATOR CUFF REPR","code_information":[{"code":"Px00096910880","type":"CDM"},{"code":"29827","type":"HCPCS"}],"standard_charges":[{"gross_charge":4156.0,"discounted_cash":3117.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":4156.0,"discounted_cash":3117.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 29848 WRIST ENDOSCOPY/SURGERY CDM","code_information":[{"code":"Px00096910881","type":"CDM"},{"code":"29848","type":"HCPCS"}],"standard_charges":[{"gross_charge":2029.0,"discounted_cash":1521.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29871 KNEE ARTHROSCOPY/DRAINAGE","code_information":[{"code":"Px00096910883","type":"CDM"},{"code":"29871","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.0,"discounted_cash":1523.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2031.0,"discounted_cash":1523.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29880 ARTHRSCP M/L MENISECTOMY","code_information":[{"code":"Px00096910889","type":"CDM"},{"code":"29880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2209.0,"discounted_cash":1656.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2209.0,"discounted_cash":1656.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2209.0,"discounted_cash":1656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY","code_information":[{"code":"Px00096910890","type":"CDM"},{"code":"29881","type":"HCPCS"}],"standard_charges":[{"gross_charge":2130.0,"discounted_cash":1597.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2130.0,"discounted_cash":1597.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2130.0,"discounted_cash":1597.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29882 KNEE ARTHROSCOPY/SURGERY MENISCUS","code_information":[{"code":"Px00096910891","type":"CDM"},{"code":"29882","type":"HCPCS"}],"standard_charges":[{"gross_charge":2698.0,"discounted_cash":2023.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29888 KNEE ARTHRO/SURG","code_information":[{"code":"Px00096910893","type":"CDM"},{"code":"29888","type":"HCPCS"}],"standard_charges":[{"gross_charge":3789.0,"discounted_cash":2841.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 29450 APPLICATION OF LEG CAST","code_information":[{"code":"Px00096910895","type":"CDM"},{"code":"29450","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":423.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4030 CAST SUP LONG LEG FIBERGLASS","code_information":[{"code":"Px00096910908","type":"CDM"},{"code":"Q4030","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4032 CAST SUP LNG LEG PED FBRGLS","code_information":[{"code":"Px00096910909","type":"CDM"},{"code":"Q4032","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4038 CAST SUP SHRT LEG FIBERGLASS","code_information":[{"code":"Px00096910910","type":"CDM"},{"code":"Q4038","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4040 CAST SUP SHRT LEG PED FBRGLS","code_information":[{"code":"Px00096910911","type":"CDM"},{"code":"Q4040","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4042 CAST SUP LNG LEG SPLNT FBRGL","code_information":[{"code":"Px00096910912","type":"CDM"},{"code":"Q4042","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR Q4044 CAST SUP LNG LEG SPLNT PED F","code_information":[{"code":"Px00096910913","type":"CDM"},{"code":"Q4044","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 98966 PHONE ASSESSMENT BY NONPHYSICIAN 5-10 MIN CDM","code_information":[{"code":"Px00096910959","type":"CDM"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 98967 PHONE ASSESSMENT BY NONPHYSICIAN 11-20 MIN CDM","code_information":[{"code":"Px00096910960","type":"CDM"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 98968 PHONE ASSESSMENT BY NONPHYSICIAN 21-30 MIN CDM","code_information":[{"code":"Px00096910961","type":"CDM"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64488 TAP BLOCK BILATERAL BY INJECTION(S)","code_information":[{"code":"Px00096910983","type":"CDM"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":172.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64486 TAP BLOCK UNIL BY INJECTION","code_information":[{"code":"Px00096911118","type":"CDM"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 97607 NEG PRESSURE WOUND TX USING DISPOSABLE NON-DME LTE 50 SQ CM","code_information":[{"code":"Px00096911124","type":"CDM"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":959.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1279.0,"discounted_cash":959.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 99497 ADVNCD CARE PLAN 30 MIN","code_information":[{"code":"Px00096911127","type":"CDM"},{"code":"99497","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":236.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 96160 HLTH RSK ASSESS PT FOCUSED","code_information":[{"code":"Px00096911437","type":"CDM"},{"code":"96160","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":12.0,"discounted_cash":9.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96161 HLTH RSK ASSESS CG FOCUSED","code_information":[{"code":"Px00096911438","type":"CDM"},{"code":"96161","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 87207 SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00097100013","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100015","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100016","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR #","code_information":[{"code":"Px00097100017","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100018","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100019","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100020","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100021","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100022","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100023","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100024","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100025","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100026","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100027","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100028","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100029","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100030","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100031","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100032","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100033","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100034","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100035","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100036","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR LAB","code_information":[{"code":"Px00097100037","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100038","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100039","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERPR CDM","code_information":[{"code":"Px00097100040","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88108 CYTP CONCENTRATION SMEARS & INTERPRETATION","code_information":[{"code":"Px00097100041","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION #","code_information":[{"code":"Px00097100042","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":617.0,"discounted_cash":462.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":617.0,"discounted_cash":462.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 88360 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","code_information":[{"code":"Px00097110005","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":342.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88141 BILL CYTO GYN W-PATH INTERP","code_information":[{"code":"Px00097110007","type":"CDM"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":269.0,"discounted_cash":201.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88112 BILL CYTO NON GYN LBC-INT","code_information":[{"code":"Px00097110012","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88323 BILL SURG CONSULT BLOCKS","code_information":[{"code":"Px00097110016","type":"CDM"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":333.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88325 BILL SURG CONSULT REFER COMP","code_information":[{"code":"Px00097110017","type":"CDM"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":381.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88321 BILL SURG CONSULT SLIDES","code_information":[{"code":"Px00097110018","type":"CDM"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88311 BILL SURG DECAL","code_information":[{"code":"Px00097110019","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88329 BILL SURG GRSS INTRAOP CONSLT","code_information":[{"code":"Px00097110025","type":"CDM"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88368 BILL SURG HER2NEU BY FISH","code_information":[{"code":"Px00097110026","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88346 BILL SURG IF","code_information":[{"code":"Px00097110027","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":431.0,"discounted_cash":323.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88300 BILL SURG LEVEL 1","code_information":[{"code":"Px00097110041","type":"CDM"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88302 BILL SURG LEVEL 2","code_information":[{"code":"Px00097110042","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88304 BILL SURG LEVEL 3","code_information":[{"code":"Px00097110043","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88305 BILL SURG LEVEL 4","code_information":[{"code":"Px00097110044","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":206.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88307 BILL SURG LEVEL 5","code_information":[{"code":"Px00097110045","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":825.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88309 BILL SURG LEVEL 6","code_information":[{"code":"Px00097110046","type":"CDM"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.0,"discounted_cash":1233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":429.0,"discounted_cash":321.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":315.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":136.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":230.0,"discounted_cash":172.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88365 IN SITU HYBRIDIZATION","code_information":[{"code":"Px00097110060","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88291 INTERP AND REPORT (PCPNL)","code_information":[{"code":"Px00097110068","type":"CDM"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":98.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 86077 BB ANTIBODY EVALUATION","code_information":[{"code":"Px00097110093","type":"CDM"},{"code":"86077","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 86078 TRANSFUSION REACT PATH REVIEW","code_information":[{"code":"Px00097110095","type":"CDM"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88173 BILL CYTO FNA INTERP","code_information":[{"code":"Px00097110098","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 82272 OCCULT BLD FECES 1-3 TESTS","code_information":[{"code":"Px00097110116","type":"CDM"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 85097 BONE MARROW INTERPRETATION","code_information":[{"code":"Px00097110117","type":"CDM"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION","code_information":[{"code":"Px00097110120","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION - REVIEW","code_information":[{"code":"Px00097110121","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88361 TUMOR IHC COMPUTER","code_information":[{"code":"Px00097110127","type":"CDM"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88368 M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL","code_information":[{"code":"Px00097110136","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":370.0,"discounted_cash":277.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88344 IMMUNOHISTO ANTIBODY SLIDE EA MULTIPLEX","code_information":[{"code":"Px00097110164","type":"CDM"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":495.0,"discounted_cash":371.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88366 INSITU HYBRIDIZATION (FISH) EA MULTIPLEX","code_information":[{"code":"Px00097110166","type":"CDM"},{"code":"88366","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88369 M/PHMTRC ALYSISHQUANT/SEMIQ MANUAL","code_information":[{"code":"Px00097110167","type":"CDM"},{"code":"88369","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":376.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88374 M/PHMTRC ALYS ISHQUANT/SEMIQ COMPUTER EA MULTIPLEX","code_information":[{"code":"Px00097110169","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":784.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88377 M/PHMTRC ALYS ISHQUANT/SEMIQ MANUAL EA MULTIPLEX","code_information":[{"code":"Px00097110170","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1489.0,"discounted_cash":1116.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 84165 PROTEIN E-PHORESIS SERUM","code_information":[{"code":"Px00097110173","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 84166 PROTEIN E-PHORESIS/URINE/CSF","code_information":[{"code":"Px00097110174","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 86334 IMMUNOFIX E-PHORESIS SERUM","code_information":[{"code":"Px00097110175","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 86335 IMMUNFIX E-PHORSIS/URINE/CSF","code_information":[{"code":"Px00097110176","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0452 MOLECULAR PATHOLOGY INTERP","code_information":[{"code":"Px00097110198","type":"CDM"},{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 88350 IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN","code_information":[{"code":"Px00097110210","type":"CDM"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":275.0,"discounted_cash":206.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 74300 XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00097210002","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":75.0,"discounted_cash":56.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 74420 UROGRAPHY RETROGRADE","code_information":[{"code":"Px00097210003","type":"CDM"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 76811 US OB DETAILED SINGLE FETUS","code_information":[{"code":"Px00097210006","type":"CDM"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":510.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76816 US OB FOLLOW-UP PER FETUS","code_information":[{"code":"Px00097210008","type":"CDM"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":312.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76818 US FETAL BIOPHYS PROFILE W/NST","code_information":[{"code":"Px00097210009","type":"CDM"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":342.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76830 US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00097210010","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":339.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":452.0,"discounted_cash":339.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76831 SALINE INFUSED SONOHYSTEROGRAM","code_information":[{"code":"Px00097210011","type":"CDM"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":328.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76857 US EXAM PELVIC LIMITED","code_information":[{"code":"Px00097210012","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":192.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76937 US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00097210015","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 77001 FLUOROGUIDE FOR VEIN DEVICE","code_information":[{"code":"Px00097210018","type":"CDM"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":279.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93880 DUPLEX EXTRACRANIAL STUDY BILAT","code_information":[{"code":"Px00097210020","type":"CDM"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":539.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 76942 US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00097210029","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":170.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93922 ABI BILAT LTD W DOPP","code_information":[{"code":"Px00097210043","type":"CDM"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":235.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":314.0,"discounted_cash":235.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 74450 URETHROCYSTOGRAM RETRO","code_information":[{"code":"Px00097210108","type":"CDM"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 74300 XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00097210239","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49083 ABD PARACENT W/IMAG GUIDANCE","code_information":[{"code":"Px00097210305","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":302.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING","code_information":[{"code":"Px00097210312","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25565 CLOSED RX RAD/ULNA SHAFT FX MANIP  CDM","code_information":[{"code":"Px00097500027","type":"CDM"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1853.0,"discounted_cash":1389.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","code_information":[{"code":"Px00097500028","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26720 CLOSE RX PROX/MID FING SHFT FX  CDM","code_information":[{"code":"Px00097500030","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":774.0,"discounted_cash":580.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26725 CLOSE RX PROX/MID FING SHFT FX MANIP  CDM","code_information":[{"code":"Px00097500031","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":1038.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1384.0,"discounted_cash":1038.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1233.0,"discounted_cash":924.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27752 CLOSED RX TIBIA SHAFT FX MANIPULATN  CDM","code_information":[{"code":"Px00097500035","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":2131.0,"discounted_cash":1598.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2131.0,"discounted_cash":1598.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1946.0,"discounted_cash":1459.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27818 CLOSED RX TRIMALLEOLAR FX MANIP  CDM","code_information":[{"code":"Px00097500037","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1759.0,"discounted_cash":1319.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28400 CLOSED RX HEEL FX  CDM","code_information":[{"code":"Px00097500038","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.0,"discounted_cash":744.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":993.0,"discounted_cash":744.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":923.0,"discounted_cash":692.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26055 INCISE FINGER TENDON SHEATH (26055) CDM","code_information":[{"code":"Px00097500047","type":"CDM"},{"code":"26055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1165.0,"discounted_cash":873.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27446 PLASTY KNEE MED OR LAT COMPARTMT (27446) CDM","code_information":[{"code":"Px00097500049","type":"CDM"},{"code":"27446","type":"HCPCS"}],"standard_charges":[{"gross_charge":4463.0,"discounted_cash":3347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29877 KNEE SCOPE SHAVE ARTICULAR CARTILAGE CDM","code_information":[{"code":"Px00097500050","type":"CDM"},{"code":"29877","type":"HCPCS"}],"standard_charges":[{"gross_charge":2440.0,"discounted_cash":1830.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46320 EXC THROMBOSED HEMORRHOID XTRNL","code_information":[{"code":"Px00097500066","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32551 INSERTION OF CHEST TUBE","code_information":[{"code":"Px00097500095","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":442.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58999 GENITAL SURGERY PROCEDURE, FEMALE UNLISTED","code_information":[{"code":"Px00097500121","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":412.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":550.0,"discounted_cash":412.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26952 AMPUTATE FINGER/THUMB SINGLE W/LOCAL ADV FLAPS CDM","code_information":[{"code":"Px00097500122","type":"CDM"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.0,"discounted_cash":1995.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM CDM","code_information":[{"code":"Px00097500132","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":888.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1185.0,"discounted_cash":888.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":756.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27828 OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA CDM","code_information":[{"code":"Px00097500139","type":"CDM"},{"code":"27828","type":"HCPCS"}],"standard_charges":[{"gross_charge":5142.0,"discounted_cash":3856.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49591 RPR AA HERNIA 1ST/LESS THAN 3 CM REDUCIBLE CDM","code_information":[{"code":"Px00097500163","type":"CDM"},{"code":"49591","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49592 RPR AA HERNIA 1ST/LESS THAN 3 CM NCRC8/STRANGULATED CDM","code_information":[{"code":"Px00097500164","type":"CDM"},{"code":"49592","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.0,"discounted_cash":1377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49593 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE CDM","code_information":[{"code":"Px00097500165","type":"CDM"},{"code":"49593","type":"HCPCS"}],"standard_charges":[{"gross_charge":2208.0,"discounted_cash":1656.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49594 RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED CDM","code_information":[{"code":"Px00097500166","type":"CDM"},{"code":"49594","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":2154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE CDM","code_information":[{"code":"Px00097500167","type":"CDM"},{"code":"49595","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":2232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49596 RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED CDM","code_information":[{"code":"Px00097500168","type":"CDM"},{"code":"49596","type":"HCPCS"}],"standard_charges":[{"gross_charge":3953.0,"discounted_cash":2964.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49613 RPR AA HERNIA RECUR/LESS THAN 3 CM REDUCIBLE CDM","code_information":[{"code":"Px00097500169","type":"CDM"},{"code":"49613","type":"HCPCS"}],"standard_charges":[{"gross_charge":1623.0,"discounted_cash":1217.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49614 RPR AA HERNIA RECUR/LESS THAN 3 CM NCRC8/STRANGULATED CDM","code_information":[{"code":"Px00097500170","type":"CDM"},{"code":"49614","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":1651.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49615 RPR AA HERNIA RECR 3-10 CM REDUCIBLE CDM","code_information":[{"code":"Px00097500171","type":"CDM"},{"code":"49615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":1845.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49616 RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED CDM","code_information":[{"code":"Px00097500172","type":"CDM"},{"code":"49616","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":2478.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49617 RPR AA HERNIA RECR > 10 CM REDUCIBLE CDM","code_information":[{"code":"Px00097500173","type":"CDM"},{"code":"49617","type":"HCPCS"}],"standard_charges":[{"gross_charge":3420.0,"discounted_cash":2565.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49618 RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED CDM","code_information":[{"code":"Px00097500174","type":"CDM"},{"code":"49618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4791.0,"discounted_cash":3593.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 15778 IMPL ABSRB MESH/PRSTH DLYD CLSR DFCT INFCTJ/TRMA CDM","code_information":[{"code":"Px00097500177","type":"CDM"},{"code":"15778","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":1128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49621 RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE CDM","code_information":[{"code":"Px00097500195","type":"CDM"},{"code":"49621","type":"HCPCS"}],"standard_charges":[{"gross_charge":2898.0,"discounted_cash":2173.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49622 RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED CDM","code_information":[{"code":"Px00097500196","type":"CDM"},{"code":"49622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3604.0,"discounted_cash":2703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49623 RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR CDM","code_information":[{"code":"Px00097500197","type":"CDM"},{"code":"49623","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":583.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26123 FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR CDM","code_information":[{"code":"Px00097500235","type":"CDM"},{"code":"26123","type":"HCPCS"}],"standard_charges":[{"gross_charge":3304.0,"discounted_cash":2478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26145 SYNVCT TDN SHTH RAD FLXR TDN PALM &/FNGR EA TDN CDM","code_information":[{"code":"Px00097500237","type":"CDM"},{"code":"26145","type":"HCPCS"}],"standard_charges":[{"gross_charge":2048.0,"discounted_cash":1536.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26418 REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH CDM","code_information":[{"code":"Px00097500238","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2418.0,"discounted_cash":1813.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26951 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR CDM","code_information":[{"code":"Px00097500244","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":2738.0,"discounted_cash":2053.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44205 LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM CDM","code_information":[{"code":"Px00097500259","type":"CDM"},{"code":"44205","type":"HCPCS"}],"standard_charges":[{"gross_charge":5114.0,"discounted_cash":3835.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11046 DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM CDM","code_information":[{"code":"Px00097500268","type":"CDM"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":155.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29822 SHOULDER ARTHROSCOPY/SURGERY DEBRIDEMENT CDM","code_information":[{"code":"Px00097500277","type":"CDM"},{"code":"29822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1599.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29823 SHLDR ARTHROSCOPY/SURG CDM","code_information":[{"code":"Px00097500278","type":"CDM"},{"code":"29823","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":1744.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26210 EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER CDM","code_information":[{"code":"Px00097500286","type":"CDM"},{"code":"26210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":1336.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20103 EXPLORATION PENETRATING WOUND SPX EXTREMITY CDM","code_information":[{"code":"Px00097500304","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.0,"discounted_cash":1000.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28272 CAPSULOTOMY IPHAL JOINT EACH JOINT SPX CDM","code_information":[{"code":"Px00097500343","type":"CDM"},{"code":"28272","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":980.0,"discounted_cash":735.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 36620 ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ CDM","code_information":[{"code":"Px00097500353","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":123.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27823 OPEN TX TRIMALLEOLAR ANKLE FX W/FIX PST LIP CDM","code_information":[{"code":"Px00097500379","type":"CDM"},{"code":"27823","type":"HCPCS"}],"standard_charges":[{"gross_charge":3826.0,"discounted_cash":2869.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11000 DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF CDM","code_information":[{"code":"Px00097500412","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25448 ARTHRP NTRCRPL/CRP/MTCRP SSP CDM","code_information":[{"code":"Px00097500444","type":"CDM"},{"code":"25448","type":"HCPCS"}],"standard_charges":[{"gross_charge":3474.0,"discounted_cash":2605.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS CDM","code_information":[{"code":"Px00097500445","type":"CDM"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64425 NERVE BLOCK INJ ILIOINGUINAL CDM","code_information":[{"code":"Px00097500500","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55707 BIOPSY PROSTATE TRANSRECTAL ULTRASOUND-GUIDED CDM","code_information":[{"code":"Px00097500541","type":"CDM"},{"code":"55707","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":758.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55708 BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST CDM","code_information":[{"code":"Px00097500542","type":"CDM"},{"code":"55708","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":758.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55709 BX PROSTATE TRANSPERINEAL ULTRASOUND-GUIDED CDM","code_information":[{"code":"Px00097500543","type":"CDM"},{"code":"55709","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":758.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0105 COLORECTAL SCRN HI RISK IND","code_information":[{"code":"Px00097510012","type":"CDM"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":972.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":701.0,"discounted_cash":525.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0121 COLORECTAL SCRN NOT HI RISK IND","code_information":[{"code":"Px00097510013","type":"CDM"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":973.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":703.0,"discounted_cash":527.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00097510016","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 97598 DEBRIDEMENT OPEN WOUND EACH ADDL 20 SQ CM CDM","code_information":[{"code":"Px00097510018","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11004 DEBRIDE GENITALIA & PERINEUM","code_information":[{"code":"Px00097510031","type":"CDM"},{"code":"11004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2164.0,"discounted_cash":1623.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11011 DEBRIDE SKIN MUSC AT FX SITE","code_information":[{"code":"Px00097510034","type":"CDM"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.0,"discounted_cash":861.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11012 DEB SKIN BONE AT FX SITE","code_information":[{"code":"Px00097510036","type":"CDM"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.0,"discounted_cash":1197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11055 TRIM SKIN LESION","code_information":[{"code":"Px00097510038","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":269.0,"discounted_cash":201.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11056 TRIM SKIN LESIONS 2 TO 4","code_information":[{"code":"Px00097510039","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":234.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11200 REMOVAL OF SKIN TAGS","code_information":[{"code":"Px00097510044","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":267.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":357.0,"discounted_cash":267.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":298.0,"discounted_cash":223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11201 REMOVE SKIN TAGS ADD-ON","code_information":[{"code":"Px00097510045","type":"CDM"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11300 SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG","code_information":[{"code":"Px00097510046","type":"CDM"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":283.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":378.0,"discounted_cash":283.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":129.0,"discounted_cash":96.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11301 SHAVE SKIN LESION 0.6 TO 1.0 CM TRNK ARM LEG","code_information":[{"code":"Px00097510048","type":"CDM"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":345.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":460.0,"discounted_cash":345.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":197.0,"discounted_cash":147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11302 SHAVE SKIN LESION 1.1 TO 2.0 CM TRNK ARM LEG","code_information":[{"code":"Px00097510050","type":"CDM"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":390.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":521.0,"discounted_cash":390.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":229.0,"discounted_cash":171.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11307 SHAVE SKIN LESION 1.1 TO 2.0 CM SCLP NK HND FT GEN","code_information":[{"code":"Px00097510056","type":"CDM"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11310 SHAVE SKIN LESION 0.5 CM OR LESS FACE ERS EYLD NSE LPS MUC","code_information":[{"code":"Px00097510060","type":"CDM"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":327.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":173.0,"discounted_cash":129.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11311 SHAVE SKIN LESION 0.6 TO 1.0 CM FACE ERS EYLD NSE LPS MUC","code_information":[{"code":"Px00097510063","type":"CDM"},{"code":"11311","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":390.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":241.0,"discounted_cash":180.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS","code_information":[{"code":"Px00097510066","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":369.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":492.0,"discounted_cash":369.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":329.0,"discounted_cash":246.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11402 EXC TR-EXT B9+MARG 1.1-2 CM","code_information":[{"code":"Px00097510068","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":495.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":660.0,"discounted_cash":495.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":449.0,"discounted_cash":336.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11403 EXC SKIN BENIG 2.1-3CM TRUNK, ARM, LEG","code_information":[{"code":"Px00097510070","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":573.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":764.0,"discounted_cash":573.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":776.0,"discounted_cash":582.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":585.0,"discounted_cash":438.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/OR LESS","code_information":[{"code":"Px00097510074","type":"CDM"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11422 EXC H-F-NK-SP B9+MARG 1.1-2","code_information":[{"code":"Px00097510075","type":"CDM"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":517.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":690.0,"discounted_cash":517.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":531.0,"discounted_cash":398.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11423 EXC H-F-NK-SP B9+MARG 2.1-3","code_information":[{"code":"Px00097510076","type":"CDM"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":596.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":616.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11426 EXC H-F-NK-SP B9+MARG > 4 CM","code_information":[{"code":"Px00097510077","type":"CDM"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":1274.0,"discounted_cash":955.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1046.0,"discounted_cash":784.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS","code_information":[{"code":"Px00097510078","type":"CDM"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":410.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":417.0,"discounted_cash":312.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11442 EXC FACE-MM B9+MARG 1.1-2 CM","code_information":[{"code":"Px00097510079","type":"CDM"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":558.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":744.0,"discounted_cash":558.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":572.0,"discounted_cash":429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11443 EXC FACE-MM B9+MARG 2.1-3 CM","code_information":[{"code":"Px00097510080","type":"CDM"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":660.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":881.0,"discounted_cash":660.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11444 EXC FACE-MM B9+MARG 3.1-4 CM","code_information":[{"code":"Px00097510081","type":"CDM"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":882.0,"discounted_cash":661.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11621 EXC H-F-NK-SP MLG+MARG 0.6-1","code_information":[{"code":"Px00097510082","type":"CDM"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":434.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11622 EXC H-F-NK-SP MLG+MARG 1.1-2","code_information":[{"code":"Px00097510083","type":"CDM"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.0,"discounted_cash":729.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":972.0,"discounted_cash":729.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":653.0,"discounted_cash":489.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11623 EXC H-F-NK-SP MLG+MARG 2.1-3","code_information":[{"code":"Px00097510084","type":"CDM"},{"code":"11623","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.0,"discounted_cash":604.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11624 EXC H-F-NK-SP MLG+MARG 3.1-4","code_information":[{"code":"Px00097510085","type":"CDM"},{"code":"11624","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"discounted_cash":686.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11626 EXC H-F-NK-SP MLG+MAR > 4 CM","code_information":[{"code":"Px00097510086","type":"CDM"},{"code":"11626","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11641 EXC FACE-MM MALIG+MARG 0.6-1","code_information":[{"code":"Px00097510088","type":"CDM"},{"code":"11641","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":682.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 11642 EXC FACE-MM MALIG+MARG 1.1-2","code_information":[{"code":"Px00097510089","type":"CDM"},{"code":"11642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":772.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11643 EXC FACE-MM MALIG+MARG 2.1-3","code_information":[{"code":"Px00097510090","type":"CDM"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":911.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1215.0,"discounted_cash":911.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11646 EXC FACE-MM MLG+MARG > 4 CM","code_information":[{"code":"Px00097510092","type":"CDM"},{"code":"11646","type":"HCPCS"}],"standard_charges":[{"gross_charge":1494.0,"discounted_cash":1120.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11770 REMOVAL OF PILONIDAL LESION SIMPLE","code_information":[{"code":"Px00097510093","type":"CDM"},{"code":"11770","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":537.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11772 REMOVAL OF PILONIDAL LESION","code_information":[{"code":"Px00097510095","type":"CDM"},{"code":"11772","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2224.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2253.0,"discounted_cash":1689.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11981 INSERT DRUG IMPLANT DEVICE","code_information":[{"code":"Px00097510097","type":"CDM"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":291.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":388.0,"discounted_cash":291.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":242.0,"discounted_cash":181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11982 REMOVE DRUG IMPLANT DEVICE","code_information":[{"code":"Px00097510098","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":318.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":279.0,"discounted_cash":209.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11983 REMOVE/INSERT DRUG IMPLANT","code_information":[{"code":"Px00097510099","type":"CDM"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":408.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43752 NASAL/OROGASTRIC W/STENT","code_information":[{"code":"Px00097510101","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 47001 NEEDLE BIOPSY LIVER ADD-ON","code_information":[{"code":"Px00097510103","type":"CDM"},{"code":"47001","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 38792 IDENTIFY SENTINEL NODE","code_information":[{"code":"Px00097510107","type":"CDM"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 54235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT","code_information":[{"code":"Px00097510108","type":"CDM"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":215.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 30100 INTRANASAL BIOPSY","code_information":[{"code":"Px00097510109","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":399.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":532.0,"discounted_cash":399.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 30117 EXCISION/DESTRUCTION INTRANASAL LESION INTRNL APPR CDM","code_information":[{"code":"Px00097510112","type":"CDM"},{"code":"30117","type":"HCPCS"}],"standard_charges":[{"gross_charge":3672.0,"discounted_cash":2754.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3672.0,"discounted_cash":2754.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE","code_information":[{"code":"Px00097510130","type":"CDM"},{"code":"49505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2040.0,"discounted_cash":1530.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2040.0,"discounted_cash":1530.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2040.0,"discounted_cash":1530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 30560 RELEASE OF NASAL ADHESIONS","code_information":[{"code":"Px00097510131","type":"CDM"},{"code":"30560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1203.0,"discounted_cash":902.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1203.0,"discounted_cash":902.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 31233 NASAL/SINUS ENDOSCOPY DX","code_information":[{"code":"Px00097510141","type":"CDM"},{"code":"31233","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":777.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1037.0,"discounted_cash":777.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 31235 NASAL/SINUS ENDOSCOPY DX W/ SPHEN","code_information":[{"code":"Px00097510142","type":"CDM"},{"code":"31235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1187.0,"discounted_cash":890.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1187.0,"discounted_cash":890.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 31237 NASAL/SINUS ENDOSCOPY SURG W/ BIOPSY","code_information":[{"code":"Px00097510143","type":"CDM"},{"code":"31237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":764.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1019.0,"discounted_cash":764.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 43255 EGD CONTROL BLEEDING ANY","code_information":[{"code":"Px00097510144","type":"CDM"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2323.0,"discounted_cash":1742.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2323.0,"discounted_cash":1742.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":759.0,"discounted_cash":569.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 31240 NASAL/SINUS ENDOSCOPY SURG W/ RESECTION","code_information":[{"code":"Px00097510147","type":"CDM"},{"code":"31240","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":459.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":613.0,"discounted_cash":459.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 31535 LARYNGOSCOPY W/BIOPSY","code_information":[{"code":"Px00097510168","type":"CDM"},{"code":"31535","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":546.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":728.0,"discounted_cash":546.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 35840 EXPL POST OP HEMRRG THROMBOSIS/INFCTN ABDOMEN CDM","code_information":[{"code":"Px00097510203","type":"CDM"},{"code":"35840","type":"HCPCS"}],"standard_charges":[{"gross_charge":4672.0,"discounted_cash":3504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 38500 BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"Px00097510220","type":"CDM"},{"code":"38500","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":741.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 38505 NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"Px00097510221","type":"CDM"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":244.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 38510 BIOPSY/REMOVAL LYMPH NODES OPEN, DEEP CERVICAL NODE(S)","code_information":[{"code":"Px00097510222","type":"CDM"},{"code":"38510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.0,"discounted_cash":1523.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2031.0,"discounted_cash":1523.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 38525 BIOPSY/REMOVAL LYMPH NODES, DEEP AUXILLARY","code_information":[{"code":"Px00097510224","type":"CDM"},{"code":"38525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1719.0,"discounted_cash":1289.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1719.0,"discounted_cash":1289.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1719.0,"discounted_cash":1289.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 38745 REMOVE ARMPIT LYMPH NODES, COMPLETE","code_information":[{"code":"Px00097510233","type":"CDM"},{"code":"38745","type":"HCPCS"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2571.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 40490 BIOPSY OF LIP","code_information":[{"code":"Px00097510235","type":"CDM"},{"code":"40490","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":351.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":468.0,"discounted_cash":351.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 40808 BIOPSY OF MOUTH LESION","code_information":[{"code":"Px00097510238","type":"CDM"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":484.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":646.0,"discounted_cash":484.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 41100 BIOPSY OF TONGUE","code_information":[{"code":"Px00097510239","type":"CDM"},{"code":"41100","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":537.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":716.0,"discounted_cash":537.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 41108 BIOPSY OF FLOOR OF MOUTH","code_information":[{"code":"Px00097510241","type":"CDM"},{"code":"41108","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":483.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 42100 BIOPSY ROOF OF MOUTH","code_information":[{"code":"Px00097510248","type":"CDM"},{"code":"42100","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":419.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 42104 EXCISION LESION MOUTH ROOF","code_information":[{"code":"Px00097510249","type":"CDM"},{"code":"42104","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":624.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":832.0,"discounted_cash":624.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 42330 REMOVAL OF SALIVARY STONE","code_information":[{"code":"Px00097510253","type":"CDM"},{"code":"42330","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":675.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":900.0,"discounted_cash":675.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 42415 EXCISE PAROTID GLAND/LESION, W/ NERVE DISSECTION","code_information":[{"code":"Px00097510258","type":"CDM"},{"code":"42415","type":"HCPCS"}],"standard_charges":[{"gross_charge":4095.0,"discounted_cash":3071.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 42800 BIOPSY OF THROAT","code_information":[{"code":"Px00097510265","type":"CDM"},{"code":"42800","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":456.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":608.0,"discounted_cash":456.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 43200 ESOPHAGOSCOPY FLEXIBLE BRUSH","code_information":[{"code":"Px00097510287","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":251.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43215 ESOPHAGOSCOPY FLEX REMOVE FB","code_information":[{"code":"Px00097510289","type":"CDM"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43235 EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"Px00097510294","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.0,"discounted_cash":819.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1093.0,"discounted_cash":819.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":467.0,"discounted_cash":350.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43236 UPPER GI SCOPE W/SUBMUC INJ","code_information":[{"code":"Px00097510295","type":"CDM"},{"code":"43236","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"Px00097510296","type":"CDM"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.0,"discounted_cash":1059.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1413.0,"discounted_cash":1059.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":525.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":669.0,"discounted_cash":501.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":669.0,"discounted_cash":501.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 13160 LATE CLOSURE OF WOUND EXTENSIVE OR COMPLICATED","code_information":[{"code":"Px00097510301","type":"CDM"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3087.0,"discounted_cash":2315.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3087.0,"discounted_cash":2315.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 14021 SKIN TISSUE REARRANGEMENT 10.1 SQ CM TO 30.0 SQ CM","code_information":[{"code":"Px00097510303","type":"CDM"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":2749.0,"discounted_cash":2061.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 14040 SKIN TISSUE REARRANGEMENT 10 SQ CM OR LESS FRHD CKS","code_information":[{"code":"Px00097510304","type":"CDM"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"discounted_cash":1814.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 14041 SKIN TISSUE REARRANGEMENT 10.1 SQ CM TO 30.0 SQ CM FRHD CK","code_information":[{"code":"Px00097510305","type":"CDM"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":3581.0,"discounted_cash":2685.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3581.0,"discounted_cash":2685.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 14060 SKIN TISSUE REARRANGEMENT 10 SQ CM OR LESS EYLDS NS ERS LI","code_information":[{"code":"Px00097510306","type":"CDM"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":2975.0,"discounted_cash":2231.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 15002 WOUND PREP TRK/ARM/LEG FIRST 100 SQ CM","code_information":[{"code":"Px00097510308","type":"CDM"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":983.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 15004 WOUND PREP F/N/HF/G","code_information":[{"code":"Px00097510310","type":"CDM"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 15100 SKIN SPLT GRFT TRNK/ARM/LEG FIRST 100 SQ CM OR LESS","code_information":[{"code":"Px00097510311","type":"CDM"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.0,"discounted_cash":2511.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 15260 SKIN FULL GRAFT EEN & LIPS 20 SQ CM OR LESS","code_information":[{"code":"Px00097510314","type":"CDM"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3869.0,"discounted_cash":2901.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3869.0,"discounted_cash":2901.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION","code_information":[{"code":"Px00097510334","type":"CDM"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":262.0,"discounted_cash":196.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":212.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17003 DESTRUCT PREMALG LES 2-14","code_information":[{"code":"Px00097510335","type":"CDM"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":26.0,"discounted_cash":19.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":8.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17004 DESTROY PREMLG LESIONS 15+","code_information":[{"code":"Px00097510336","type":"CDM"},{"code":"17004","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":285.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17111 DESTRUCT LESION 15 OR MORE","code_information":[{"code":"Px00097510337","type":"CDM"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":244.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17260 DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/OR LESS","code_information":[{"code":"Px00097510338","type":"CDM"},{"code":"17260","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":288.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 19020 INCISION OF BREAST LESION","code_information":[{"code":"Px00097510353","type":"CDM"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":916.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 19100 BX BREAST PERCUT W/O IMAGE","code_information":[{"code":"Px00097510355","type":"CDM"},{"code":"19100","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 19110 NIPPLE EXPLORATION","code_information":[{"code":"Px00097510357","type":"CDM"},{"code":"19110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1851.0,"discounted_cash":1388.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 19307 MAST MOD RAD","code_information":[{"code":"Px00097510373","type":"CDM"},{"code":"19307","type":"HCPCS"}],"standard_charges":[{"gross_charge":4571.0,"discounted_cash":3428.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 19330 REMOVAL OF IMPLANT MATERIAL","code_information":[{"code":"Px00097510376","type":"CDM"},{"code":"19330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":1886.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 20240 BONE BIOPSY EXCISIONAL SUPERFICIAL","code_information":[{"code":"Px00097510379","type":"CDM"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":403.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 20605 INJ MED JOINT","code_information":[{"code":"Px00097510381","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20612 ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00097510383","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":252.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":159.0,"discounted_cash":119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 21012 EXC FACE LES SBQ 2+ CM","code_information":[{"code":"Px00097510392","type":"CDM"},{"code":"21012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":995.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1327.0,"discounted_cash":995.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 21014 EXC FACE TUM DEEP 2+ CM","code_information":[{"code":"Px00097510394","type":"CDM"},{"code":"21014","type":"HCPCS"}],"standard_charges":[{"gross_charge":2034.0,"discounted_cash":1525.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2034.0,"discounted_cash":1525.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 21552 EXC NECK LES SC 3+ CM","code_information":[{"code":"Px00097510403","type":"CDM"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1748.0,"discounted_cash":1311.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1748.0,"discounted_cash":1311.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1748.0,"discounted_cash":1311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 21554 EXC NECK TUM DEEP 5+ CM","code_information":[{"code":"Px00097510404","type":"CDM"},{"code":"21554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2847.0,"discounted_cash":2135.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 21555 EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ LESS THAN 3CM","code_information":[{"code":"Px00097510405","type":"CDM"},{"code":"21555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1254.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 21930 EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ/LESS THAN 3CM","code_information":[{"code":"Px00097510410","type":"CDM"},{"code":"21930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1942.0,"discounted_cash":1456.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1428.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 21931 EXC BACK LES SC 3+ CM","code_information":[{"code":"Px00097510411","type":"CDM"},{"code":"21931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"discounted_cash":1379.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1839.0,"discounted_cash":1379.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1839.0,"discounted_cash":1379.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 21932 EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL/LESS THAN 5CM","code_information":[{"code":"Px00097510412","type":"CDM"},{"code":"21932","type":"HCPCS"}],"standard_charges":[{"gross_charge":2595.0,"discounted_cash":1946.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 22902 EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ/LESS THAN 3CM","code_information":[{"code":"Px00097510430","type":"CDM"},{"code":"22902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.0,"discounted_cash":1365.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 22903 EXC ABD LES SC > 3 CM","code_information":[{"code":"Px00097510431","type":"CDM"},{"code":"22903","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":1292.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 23405 INCISION OF TENDON & MUSCLE","code_information":[{"code":"Px00097510439","type":"CDM"},{"code":"23405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2408.0,"discounted_cash":1806.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23410 REPAIR ROTATOR CUFF ACUTE","code_information":[{"code":"Px00097510441","type":"CDM"},{"code":"23410","type":"HCPCS"}],"standard_charges":[{"gross_charge":3209.0,"discounted_cash":2406.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 24000 EXPLORATORY ELBOW SURGERY","code_information":[{"code":"Px00097510446","type":"CDM"},{"code":"24000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1898.0,"discounted_cash":1423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 19328 REMOVAL OF BREAST IMPLANT","code_information":[{"code":"Px00097510453","type":"CDM"},{"code":"19328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":1622.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 11446 EXC FACE-MM B9+MARG > 4 CM","code_information":[{"code":"Px00097510454","type":"CDM"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":1117.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1235.0,"discounted_cash":926.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11462 REMOVAL SWEAT GLAND LESION SMP","code_information":[{"code":"Px00097510455","type":"CDM"},{"code":"11462","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11604 EXC TR-EXT MLG+MARG 3.1-4 CM","code_information":[{"code":"Px00097510457","type":"CDM"},{"code":"11604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":897.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1197.0,"discounted_cash":897.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11606 EXC TR-EXT MLG+MARG > 4 CM","code_information":[{"code":"Px00097510458","type":"CDM"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.0,"discounted_cash":1293.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1725.0,"discounted_cash":1293.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1216.0,"discounted_cash":912.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20690 APPLY BONE FIXATION DEVICE","code_information":[{"code":"Px00097510460","type":"CDM"},{"code":"20690","type":"HCPCS"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1748.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23412 REPAIR ROTATOR CUFF CHRONIC","code_information":[{"code":"Px00097510461","type":"CDM"},{"code":"23412","type":"HCPCS"}],"standard_charges":[{"gross_charge":3334.0,"discounted_cash":2500.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3334.0,"discounted_cash":2500.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11771 REMOVAL OF PILONIDAL LESION EXTEN","code_information":[{"code":"Px00097510462","type":"CDM"},{"code":"11771","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.0,"discounted_cash":1812.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1754.0,"discounted_cash":1315.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11043 DEBRIDEMENT MUSCLES/FASCIA FIRST 20 SQ CM OR LESS","code_information":[{"code":"Px00097510465","type":"CDM"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":588.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":591.0,"discounted_cash":443.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23430 REPAIR TENODESIS OF BICEP","code_information":[{"code":"Px00097510467","type":"CDM"},{"code":"23430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2917.0,"discounted_cash":2187.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26020 DRAIN HAND TENDON SHEATH","code_information":[{"code":"Px00097510468","type":"CDM"},{"code":"26020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1650.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2200.0,"discounted_cash":1650.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26080 ARTHROTOMY W/EXPLORE/TREAT INTERPHALANGEAL JOINT","code_information":[{"code":"Px00097510469","type":"CDM"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1590.0,"discounted_cash":1192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36582 REPLACE TUNNELED CV CATH","code_information":[{"code":"Px00097510475","type":"CDM"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":1091.0,"discounted_cash":818.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27487 REVSN TOTAL KNEE ARTHRP W/WO ALGRFT FEM&ENTIRE TIBIAL CMPNT CDM","code_information":[{"code":"Px00097510499","type":"CDM"},{"code":"27487","type":"HCPCS"}],"standard_charges":[{"gross_charge":6784.0,"discounted_cash":5088.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43247 OPERATIVE UPPER GI ENDOSCOPY W/ FB REMOVAL","code_information":[{"code":"Px00097510501","type":"CDM"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1450.0,"discounted_cash":1087.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1450.0,"discounted_cash":1087.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":669.0,"discounted_cash":501.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM","code_information":[{"code":"Px00097510503","type":"CDM"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":3922.0,"discounted_cash":2941.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3922.0,"discounted_cash":2941.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":582.0,"discounted_cash":436.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43251 EGD REMOVE LESION SNARE","code_information":[{"code":"Px00097510505","type":"CDM"},{"code":"43251","type":"HCPCS"}],"standard_charges":[{"gross_charge":1852.0,"discounted_cash":1389.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1852.0,"discounted_cash":1389.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":742.0,"discounted_cash":556.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43280 LAPAROSCOPY FUNDOPLASTY","code_information":[{"code":"Px00097510512","type":"CDM"},{"code":"43280","type":"HCPCS"}],"standard_charges":[{"gross_charge":4159.0,"discounted_cash":3119.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 43830 PLACE GASTROSTOMY TUBE, W/O CONSTRUCTION","code_information":[{"code":"Px00097510559","type":"CDM"},{"code":"43830","type":"HCPCS"}],"standard_charges":[{"gross_charge":2725.0,"discounted_cash":2043.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43840 REPAIR OF STOMACH LESION","code_information":[{"code":"Px00097510562","type":"CDM"},{"code":"43840","type":"HCPCS"}],"standard_charges":[{"gross_charge":5253.0,"discounted_cash":3939.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43870 REPAIR STOMACH OPENING","code_information":[{"code":"Px00097510565","type":"CDM"},{"code":"43870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.0,"discounted_cash":2058.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43886 REVISE GASTRIC PORT OPEN","code_information":[{"code":"Px00097510566","type":"CDM"},{"code":"43886","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.0,"discounted_cash":1080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44005 FREEING OF BOWEL ADHESION","code_information":[{"code":"Px00097510569","type":"CDM"},{"code":"44005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4210.0,"discounted_cash":3157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44120 REMOVAL OF SMALL INTESTINE, SINGLE RESECTION","code_information":[{"code":"Px00097510579","type":"CDM"},{"code":"44120","type":"HCPCS"}],"standard_charges":[{"gross_charge":4710.0,"discounted_cash":3532.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44121 REMOVAL OF SMALL INTESTINE, EACH ADDL RESECTION","code_information":[{"code":"Px00097510580","type":"CDM"},{"code":"44121","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":688.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44130 BOWEL TO BOWEL FUSION","code_information":[{"code":"Px00097510583","type":"CDM"},{"code":"44130","type":"HCPCS"}],"standard_charges":[{"gross_charge":5079.0,"discounted_cash":3809.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44139 MOBILIZATION OF COLON","code_information":[{"code":"Px00097510584","type":"CDM"},{"code":"44139","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44143 PARTIAL REMOVAL OF COLON, HARTMANN PROCEDURE","code_information":[{"code":"Px00097510587","type":"CDM"},{"code":"44143","type":"HCPCS"}],"standard_charges":[{"gross_charge":6336.0,"discounted_cash":4752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44145 PARTIAL REMOVAL OF COLON W/ COLOPROCTOSTOMY","code_information":[{"code":"Px00097510589","type":"CDM"},{"code":"44145","type":"HCPCS"}],"standard_charges":[{"gross_charge":6323.0,"discounted_cash":4742.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44146 PARTIAL REMOVAL OF COLON W/ COLOPROCTOSTOMY, W/ COLOSTOMY","code_information":[{"code":"Px00097510590","type":"CDM"},{"code":"44146","type":"HCPCS"}],"standard_charges":[{"gross_charge":8037.0,"discounted_cash":6027.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44150 REMOVAL OF COLON, W/O PROCTECTOMY W/ ILEOSTOMY OR ILEOPROC","code_information":[{"code":"Px00097510592","type":"CDM"},{"code":"44150","type":"HCPCS"}],"standard_charges":[{"gross_charge":7108.0,"discounted_cash":5331.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44160 REMOVAL OF COLON, PARTIAL","code_information":[{"code":"Px00097510598","type":"CDM"},{"code":"44160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4783.0,"discounted_cash":3587.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44180 LAPAROSCOPY ENTEROLYSIS","code_information":[{"code":"Px00097510599","type":"CDM"},{"code":"44180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3558.0,"discounted_cash":2668.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3558.0,"discounted_cash":2668.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3558.0,"discounted_cash":2668.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59151 ECTOPIC REPAIR LAP/SAL","code_information":[{"code":"Px00097510603","type":"CDM"},{"code":"59151","type":"HCPCS"}],"standard_charges":[{"gross_charge":2996.0,"discounted_cash":2247.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 59160 D & C AFTER DELIVERY","code_information":[{"code":"Px00097510605","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":778.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":726.0,"discounted_cash":544.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59870 EVACUATE MOLE OF UTERUS","code_information":[{"code":"Px00097510606","type":"CDM"},{"code":"59870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2072.0,"discounted_cash":1554.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26989 HAND/FINGER SURGERY UNLISTED","code_information":[{"code":"Px00097510626","type":"CDM"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27334 RMV KNEE SYNOVIUM,ANT/POST","code_information":[{"code":"Px00097510632","type":"CDM"},{"code":"27334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2705.0,"discounted_cash":2028.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27427 LIGMT REVISION,KNEE,EXTRA-ARTIC","code_information":[{"code":"Px00097510634","type":"CDM"},{"code":"27427","type":"HCPCS"}],"standard_charges":[{"gross_charge":2779.0,"discounted_cash":2084.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29828 ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS","code_information":[{"code":"Px00097510648","type":"CDM"},{"code":"29828","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.0,"discounted_cash":2678.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3571.0,"discounted_cash":2678.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51702 INSERT,TEMP INDWELLING BLAD CATH,SIMPLE","code_information":[{"code":"Px00097510653","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":177.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 56515 DESTRUCTION LESION(S)VULVA EXTENSIVE","code_information":[{"code":"Px00097510657","type":"CDM"},{"code":"56515","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":616.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64772 TRANSECT OTHR SPINAL N,XTRADURAL","code_information":[{"code":"Px00097510669","type":"CDM"},{"code":"64772","type":"HCPCS"}],"standard_charges":[{"gross_charge":2177.0,"discounted_cash":1632.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24505 CLOSED RX MID HUMERUS FX,MANIPULATN","code_information":[{"code":"Px00097510671","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.0,"discounted_cash":1515.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2021.0,"discounted_cash":1515.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1807.0,"discounted_cash":1355.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29807 SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION","code_information":[{"code":"Px00097510675","type":"CDM"},{"code":"29807","type":"HCPCS"}],"standard_charges":[{"gross_charge":4028.0,"discounted_cash":3021.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR","code_information":[{"code":"Px00097510676","type":"CDM"},{"code":"29827","type":"HCPCS"}],"standard_charges":[{"gross_charge":4156.0,"discounted_cash":3117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR","code_information":[{"code":"Px00097510677","type":"CDM"},{"code":"29888","type":"HCPCS"}],"standard_charges":[{"gross_charge":3789.0,"discounted_cash":2841.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 14001 ADJ TISS XFER TRUNK 10.1-30","code_information":[{"code":"Px00097510679","type":"CDM"},{"code":"14001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2537.0,"discounted_cash":1902.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 41826 EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR","code_information":[{"code":"Px00097510687","type":"CDM"},{"code":"41826","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.0,"discounted_cash":863.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1151.0,"discounted_cash":863.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 64999 N BLOCK INJ PHRENIC CDM","code_information":[{"code":"Px00097510699","type":"CDM"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":523.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44188 LAPAROSCOPY COLOSTOMY","code_information":[{"code":"Px00097510701","type":"CDM"},{"code":"44188","type":"HCPCS"}],"standard_charges":[{"gross_charge":4658.0,"discounted_cash":3493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44207 LAPAROSCOPY COLECTOMY/COLOPROCTOSTOMY","code_information":[{"code":"Px00097510704","type":"CDM"},{"code":"44207","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.0,"discounted_cash":5187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44213 LAPAROSCOPY MOBILIZATION SPLENIC FLEXURE ADD-ON","code_information":[{"code":"Px00097510705","type":"CDM"},{"code":"44213","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":531.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44238 LAPAROSCOPE PROC INTESTINE","code_information":[{"code":"Px00097510706","type":"CDM"},{"code":"44238","type":"HCPCS"}],"standard_charges":[{"gross_charge":2765.0,"discounted_cash":2073.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 44310 ILEOSTOMY/JEJUNOSTOMY","code_information":[{"code":"Px00097510707","type":"CDM"},{"code":"44310","type":"HCPCS"}],"standard_charges":[{"gross_charge":4001.0,"discounted_cash":3000.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44314 REVISION ILEOSTOMY COMPLIC RCNSTN IN-DEPTH SPX CDM","code_information":[{"code":"Px00097510708","type":"CDM"},{"code":"44314","type":"HCPCS"}],"standard_charges":[{"gross_charge":3862.0,"discounted_cash":2896.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44320 COLOSTOMY","code_information":[{"code":"Px00097510709","type":"CDM"},{"code":"44320","type":"HCPCS"}],"standard_charges":[{"gross_charge":4625.0,"discounted_cash":3468.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44388 DX COLONOSCOPY THRU STOMA INCLUDING COLLTN SPEC SP PRCD CDM","code_information":[{"code":"Px00097510717","type":"CDM"},{"code":"44388","type":"HCPCS"}],"standard_charges":[{"gross_charge":1208.0,"discounted_cash":906.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":595.0,"discounted_cash":446.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44389 COLONOSCOPY THRU STOMA W/BIOPSY SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00097510718","type":"CDM"},{"code":"44389","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":489.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44394 COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE CDM","code_information":[{"code":"Px00097510723","type":"CDM"},{"code":"44394","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.0,"discounted_cash":640.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44604 SUTURE LARGE INTESTINE","code_information":[{"code":"Px00097510726","type":"CDM"},{"code":"44604","type":"HCPCS"}],"standard_charges":[{"gross_charge":4054.0,"discounted_cash":3040.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44625 REPAIR BOWEL OPENING, W/ RESECTION","code_information":[{"code":"Px00097510729","type":"CDM"},{"code":"44625","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":2907.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44626 REPAIR BOWEL OPENING, HARTMANN METHOD","code_information":[{"code":"Px00097510730","type":"CDM"},{"code":"44626","type":"HCPCS"}],"standard_charges":[{"gross_charge":6090.0,"discounted_cash":4567.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44955 APPENDECTOMY ADD-ON","code_information":[{"code":"Px00097510739","type":"CDM"},{"code":"44955","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44970 LAPAROSCOPY APPENDECTOMY","code_information":[{"code":"Px00097510741","type":"CDM"},{"code":"44970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2341.0,"discounted_cash":1755.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2341.0,"discounted_cash":1755.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2341.0,"discounted_cash":1755.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45100 BIOPSY OF RECTUM","code_information":[{"code":"Px00097510744","type":"CDM"},{"code":"45100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1183.0,"discounted_cash":887.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45305 PROCTOSIGMOIDOSCOPY W/BX","code_information":[{"code":"Px00097510752","type":"CDM"},{"code":"45305","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":211.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY","code_information":[{"code":"Px00097510758","type":"CDM"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":534.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":219.0,"discounted_cash":164.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45331 SIGMOIDOSCOPY AND BIOPSY","code_information":[{"code":"Px00097510759","type":"CDM"},{"code":"45331","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":807.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1076.0,"discounted_cash":807.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":278.0,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45334 SIGMOIDOSCOPY FOR BLEEDING","code_information":[{"code":"Px00097510763","type":"CDM"},{"code":"45334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.0,"discounted_cash":1365.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":447.0,"discounted_cash":335.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45335 SIGMOIDOSCOPY W/SUBMUC INJ","code_information":[{"code":"Px00097510764","type":"CDM"},{"code":"45335","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45338 SIGMOIDOSCOPY W/TUMOR REMOVAL","code_information":[{"code":"Px00097510765","type":"CDM"},{"code":"45338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":850.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":458.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM","code_information":[{"code":"Px00097510766","type":"CDM"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":972.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1297.0,"discounted_cash":972.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":701.0,"discounted_cash":525.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45379 COLONOSCOPY W/FB REMOVAL","code_information":[{"code":"Px00097510767","type":"CDM"},{"code":"45379","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":1236.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":902.0,"discounted_cash":676.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00097510768","type":"CDM"},{"code":"45380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1641.0,"discounted_cash":1230.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1641.0,"discounted_cash":1230.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":763.0,"discounted_cash":572.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45381 COLONOSCOPY SUBMUCOUS INJ","code_information":[{"code":"Px00097510769","type":"CDM"},{"code":"45381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1254.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1673.0,"discounted_cash":1254.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":763.0,"discounted_cash":572.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45382 COLONOSCOPY/CONTROL BLEEDING","code_information":[{"code":"Px00097510770","type":"CDM"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":2481.0,"discounted_cash":1860.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":979.0,"discounted_cash":734.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45384 LESION REMOVE COLONOSCOPY","code_information":[{"code":"Px00097510772","type":"CDM"},{"code":"45384","type":"HCPCS"}],"standard_charges":[{"gross_charge":1848.0,"discounted_cash":1386.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM","code_information":[{"code":"Px00097510773","type":"CDM"},{"code":"45385","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":1292.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1723.0,"discounted_cash":1292.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":961.0,"discounted_cash":720.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45386 COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT CDM","code_information":[{"code":"Px00097510774","type":"CDM"},{"code":"45386","type":"HCPCS"}],"standard_charges":[{"gross_charge":2272.0,"discounted_cash":1704.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2272.0,"discounted_cash":1704.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":805.0,"discounted_cash":603.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45990 SURG DX EXAM ANORECTAL","code_information":[{"code":"Px00097510782","type":"CDM"},{"code":"45990","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46020 PLACEMENT OF SETON","code_information":[{"code":"Px00097510783","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":339.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":452.0,"discounted_cash":339.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":452.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46220 EXCISE ANAL EXTERNAL TAG/PAPILLA","code_information":[{"code":"Px00097510786","type":"CDM"},{"code":"46220","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":717.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":474.0,"discounted_cash":355.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46260 REMOVE INTERNAL/EXTERNAL HEMORROID GROUPS 2+","code_information":[{"code":"Px00097510791","type":"CDM"},{"code":"46260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1879.0,"discounted_cash":1409.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1879.0,"discounted_cash":1409.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1879.0,"discounted_cash":1409.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46270 REMOVE ANAL FIST SUBQ","code_information":[{"code":"Px00097510794","type":"CDM"},{"code":"46270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2072.0,"discounted_cash":1554.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1574.0,"discounted_cash":1180.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46606 ANOSCOPY AND BIOPSY","code_information":[{"code":"Px00097510798","type":"CDM"},{"code":"46606","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46945 REMOVE BY LIGATION INTERNAL HEMORROID COLUMN/GROUP","code_information":[{"code":"Px00097510806","type":"CDM"},{"code":"46945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.0,"discounted_cash":998.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1331.0,"discounted_cash":998.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 46947 HEMORRHOIDOPEXY BY STAPLING","code_information":[{"code":"Px00097510807","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":1513.0,"discounted_cash":1134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46999 ANUS SURGERY PROCEDURE","code_information":[{"code":"Px00097510808","type":"CDM"},{"code":"46999","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":321.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY","code_information":[{"code":"Px00097510818","type":"CDM"},{"code":"47562","type":"HCPCS"}],"standard_charges":[{"gross_charge":2568.0,"discounted_cash":1926.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2568.0,"discounted_cash":1926.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2568.0,"discounted_cash":1926.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH","code_information":[{"code":"Px00097510819","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.0,"discounted_cash":2094.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2792.0,"discounted_cash":2094.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2792.0,"discounted_cash":2094.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 47564 LAPAROSCOPY CHOLECYSTECTOMY/EXPLR","code_information":[{"code":"Px00097510820","type":"CDM"},{"code":"47564","type":"HCPCS"}],"standard_charges":[{"gross_charge":4335.0,"discounted_cash":3251.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":4335.0,"discounted_cash":3251.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49000 EXPLORATION OF ABDOMEN","code_information":[{"code":"Px00097510843","type":"CDM"},{"code":"49000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":2232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49002 REOPENING OF ABDOMEN","code_information":[{"code":"Px00097510844","type":"CDM"},{"code":"49002","type":"HCPCS"}],"standard_charges":[{"gross_charge":4022.0,"discounted_cash":3016.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49020 DRAIN ABDOMINAL ABSCESS, OPEN","code_information":[{"code":"Px00097510846","type":"CDM"},{"code":"49020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":4608.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49060 DRAIN OPEN RETROP ABSCESS","code_information":[{"code":"Px00097510848","type":"CDM"},{"code":"49060","type":"HCPCS"}],"standard_charges":[{"gross_charge":4262.0,"discounted_cash":3196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49255 REMOVAL OF OMENTUM","code_information":[{"code":"Px00097510855","type":"CDM"},{"code":"49255","type":"HCPCS"}],"standard_charges":[{"gross_charge":3077.0,"discounted_cash":2307.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49320 DIAGNOSTIC LAPAROSCOPY SEPARATE PROC","code_information":[{"code":"Px00097510856","type":"CDM"},{"code":"49320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.0,"discounted_cash":963.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1284.0,"discounted_cash":963.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1284.0,"discounted_cash":963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49321 LAPAROSCOPY BIOPSY","code_information":[{"code":"Px00097510858","type":"CDM"},{"code":"49321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.0,"discounted_cash":1003.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 49329 LAPAROSCOPE PROCEDURE ABDOMINAL/PERITONEUM/OMENTUM","code_information":[{"code":"Px00097510861","type":"CDM"},{"code":"49329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":1073.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1431.0,"discounted_cash":1073.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 49422 REMOVE TUNNELED INTRAPERITONEAL CATH","code_information":[{"code":"Px00097510864","type":"CDM"},{"code":"49422","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":633.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":844.0,"discounted_cash":633.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 64721 CARPAL TUNNEL SURGERY, SEPARATE PROC","code_information":[{"code":"Px00097510869","type":"CDM"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":1295.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49507 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR","code_information":[{"code":"Px00097510870","type":"CDM"},{"code":"49507","type":"HCPCS"}],"standard_charges":[{"gross_charge":2290.0,"discounted_cash":1717.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49553 REPAIR FEMORAL HERNIA INITIAL BLOCKED","code_information":[{"code":"Px00097510872","type":"CDM"},{"code":"49553","type":"HCPCS"}],"standard_charges":[{"gross_charge":2463.0,"discounted_cash":1847.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2463.0,"discounted_cash":1847.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2463.0,"discounted_cash":1847.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR, INITIAL","code_information":[{"code":"Px00097510880","type":"CDM"},{"code":"49650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1692.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49651 LAPAROSCOPY INGUINAL HERNIA REPAIR, RECURRENT","code_information":[{"code":"Px00097510881","type":"CDM"},{"code":"49651","type":"HCPCS"}],"standard_charges":[{"gross_charge":2207.0,"discounted_cash":1655.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2207.0,"discounted_cash":1655.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49659 LAPAROSCOPY PROCEDURE HERNIA REPAIR","code_information":[{"code":"Px00097510888","type":"CDM"},{"code":"49659","type":"HCPCS"}],"standard_charges":[{"gross_charge":3180.0,"discounted_cash":2385.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 24515 TREAT HUMERUS FRACTURE W/PLATE","code_information":[{"code":"Px00097510901","type":"CDM"},{"code":"24515","type":"HCPCS"}],"standard_charges":[{"gross_charge":3448.0,"discounted_cash":2586.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 24685 TREAT ULNAR FRACTURE - TRT FX","code_information":[{"code":"Px00097510907","type":"CDM"},{"code":"24685","type":"HCPCS"}],"standard_charges":[{"gross_charge":2578.0,"discounted_cash":1933.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2578.0,"discounted_cash":1933.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25075 EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ/LESS THAN 3CM","code_information":[{"code":"Px00097510908","type":"CDM"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1985.0,"discounted_cash":1488.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1248.0,"discounted_cash":936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25111 REMOVE WRST TEND LESION","code_information":[{"code":"Px00097510910","type":"CDM"},{"code":"25111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":975.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1300.0,"discounted_cash":975.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1300.0,"discounted_cash":975.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25575 TREAT FRACTURE RADIAL AND ULNA SHAFT FRACTURE W/FIXA","code_information":[{"code":"Px00097510913","type":"CDM"},{"code":"25575","type":"HCPCS"}],"standard_charges":[{"gross_charge":3551.0,"discounted_cash":2663.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3551.0,"discounted_cash":2663.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25652 OPEN TREAT FRACTURE ULNAR STYLOID","code_information":[{"code":"Px00097510917","type":"CDM"},{"code":"25652","type":"HCPCS"}],"standard_charges":[{"gross_charge":2469.0,"discounted_cash":1851.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26045 RELEASE PALM CONTRACTURE","code_information":[{"code":"Px00097510922","type":"CDM"},{"code":"26045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1878.0,"discounted_cash":1408.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1878.0,"discounted_cash":1408.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26608 PERCUTANEUS FIXATION TREAT METACARPAL FRACTURE","code_information":[{"code":"Px00097510926","type":"CDM"},{"code":"26608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1912.0,"discounted_cash":1434.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26990 DRAINAGE OF PELVIS LESION","code_information":[{"code":"Px00097510930","type":"CDM"},{"code":"26990","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.0,"discounted_cash":1988.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27047 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ/LESS THAN 3CM","code_information":[{"code":"Px00097510931","type":"CDM"},{"code":"27047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1428.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 25545 TREAT FRACTURE OF ULNA SHAFT","code_information":[{"code":"Px00097510935","type":"CDM"},{"code":"25545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2473.0,"discounted_cash":1854.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2473.0,"discounted_cash":1854.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27245 TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLT SCREW CDM","code_information":[{"code":"Px00097510937","type":"CDM"},{"code":"27245","type":"HCPCS"}],"standard_charges":[{"gross_charge":4768.0,"discounted_cash":3576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26756 PIN FINGER FRACTURE EACH","code_information":[{"code":"Px00097510938","type":"CDM"},{"code":"26756","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1266.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 25116 REMOVE WRIST/FOREARM LESION","code_information":[{"code":"Px00097510939","type":"CDM"},{"code":"25116","type":"HCPCS"}],"standard_charges":[{"gross_charge":2395.0,"discounted_cash":1796.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27310 ARTHROTOMY KNEE W/EXPL DRAINAGE/REMOVAL FB CDM","code_information":[{"code":"Px00097510940","type":"CDM"},{"code":"27310","type":"HCPCS"}],"standard_charges":[{"gross_charge":2877.0,"discounted_cash":2157.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2877.0,"discounted_cash":2157.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27327 EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ/LESS THAN 3CM","code_information":[{"code":"Px00097510942","type":"CDM"},{"code":"27327","type":"HCPCS"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":1435.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1914.0,"discounted_cash":1435.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 27328 EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC/LESS THAN 5CM","code_information":[{"code":"Px00097510943","type":"CDM"},{"code":"27328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1828.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27486 REVSN TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT CDM","code_information":[{"code":"Px00097510947","type":"CDM"},{"code":"27486","type":"HCPCS"}],"standard_charges":[{"gross_charge":5453.0,"discounted_cash":4089.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27507 OPEN TREATMENT OF THIGH FRACTURE","code_information":[{"code":"Px00097510948","type":"CDM"},{"code":"27507","type":"HCPCS"}],"standard_charges":[{"gross_charge":3766.0,"discounted_cash":2824.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27600 DCMPRN FASCIOTOMY LEG ANT&/LAT COMPARTMENTS ONLY CDM","code_information":[{"code":"Px00097510950","type":"CDM"},{"code":"27600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":1170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27652 REPAIR/GRAFT ACHILLES TENDON","code_information":[{"code":"Px00097510959","type":"CDM"},{"code":"27652","type":"HCPCS"}],"standard_charges":[{"gross_charge":2601.0,"discounted_cash":1950.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 27758 OPEN TREAT TIBIA FRACTURE","code_information":[{"code":"Px00097510961","type":"CDM"},{"code":"27758","type":"HCPCS"}],"standard_charges":[{"gross_charge":3505.0,"discounted_cash":2628.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27814 OPEN TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"Px00097510963","type":"CDM"},{"code":"27814","type":"HCPCS"}],"standard_charges":[{"gross_charge":2986.0,"discounted_cash":2239.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2986.0,"discounted_cash":2239.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2986.0,"discounted_cash":2239.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27822 OPEN TX OF ANKLE FRACTURE W/O FIXATION OF POSTERIOR","code_information":[{"code":"Px00097510964","type":"CDM"},{"code":"27822","type":"HCPCS"}],"standard_charges":[{"gross_charge":3397.0,"discounted_cash":2547.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3397.0,"discounted_cash":2547.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3397.0,"discounted_cash":2547.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28285 REPAIR OF HAMMERTOE","code_information":[{"code":"Px00097510973","type":"CDM"},{"code":"28285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1521.0,"discounted_cash":1140.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY","code_information":[{"code":"Px00097510979","type":"CDM"},{"code":"29824","type":"HCPCS"}],"standard_charges":[{"gross_charge":2659.0,"discounted_cash":1994.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29834 ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"Px00097510980","type":"CDM"},{"code":"29834","type":"HCPCS"}],"standard_charges":[{"gross_charge":1951.0,"discounted_cash":1463.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 36561 INSERT TUNNELED CV CATH W/PORT > 5","code_information":[{"code":"Px00097510986","type":"CDM"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":3561.0,"discounted_cash":2670.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3561.0,"discounted_cash":2670.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1260.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36576 REPAIR TUNNELED CV CATH W/PUMP OR PORT","code_information":[{"code":"Px00097510988","type":"CDM"},{"code":"36576","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":957.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1276.0,"discounted_cash":957.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":696.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36590 REMOVAL TUNNELED CV CATH W/PORT OR PUMP","code_information":[{"code":"Px00097510989","type":"CDM"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":636.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":849.0,"discounted_cash":636.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":723.0,"discounted_cash":542.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 37765 STAB PHLEB VEINS XTR 10-20","code_information":[{"code":"Px00097511000","type":"CDM"},{"code":"37765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":764.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52332 CYSTOURETHROSCOPY W/ INSERTION OF INDWELLING URETERAL STEN","code_information":[{"code":"Px00097511016","type":"CDM"},{"code":"52332","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":445.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55040 REMOVAL OF HYDROCELE","code_information":[{"code":"Px00097511033","type":"CDM"},{"code":"55040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1315.0,"discounted_cash":986.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55250 REMOVAL OF SPERM DUCT(S)","code_information":[{"code":"Px00097511034","type":"CDM"},{"code":"55250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1281.0,"discounted_cash":960.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":895.0,"discounted_cash":671.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 56440 SURGERY FOR VULVA LESION","code_information":[{"code":"Px00097511041","type":"CDM"},{"code":"56440","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 56605 BIOPSY OF VULVA/PERINEUM, SINGLE LESION","code_information":[{"code":"Px00097511043","type":"CDM"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":275.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":227.0,"discounted_cash":170.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 56820 EXAM OF VULVA W/SCOPE","code_information":[{"code":"Px00097511047","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 57100 BIOPSY OF VAGINA","code_information":[{"code":"Px00097511051","type":"CDM"},{"code":"57100","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":252.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57240 REPAIR BLADDER & VAGINA","code_information":[{"code":"Px00097511055","type":"CDM"},{"code":"57240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2368.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57250 REPAIR RECTUM & VAGINA","code_information":[{"code":"Px00097511056","type":"CDM"},{"code":"57250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2376.0,"discounted_cash":1782.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2376.0,"discounted_cash":1782.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 57260 REPAIR OF VAGINA, COMBINED ANTEROPOSTERIOR COLPORRHAPHY","code_information":[{"code":"Px00097511057","type":"CDM"},{"code":"57260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3000.0,"discounted_cash":2250.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3000.0,"discounted_cash":2250.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3000.0,"discounted_cash":2250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57265 EXTENSIVE REPAIR OF VAGINA","code_information":[{"code":"Px00097511058","type":"CDM"},{"code":"57265","type":"HCPCS"}],"standard_charges":[{"gross_charge":3355.0,"discounted_cash":2516.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57288 REPAIR BLADDER DEFECT","code_information":[{"code":"Px00097511065","type":"CDM"},{"code":"57288","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":2154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2872.0,"discounted_cash":2154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57295 REVISE VAGINAL GRAFT VIA VAGINA","code_information":[{"code":"Px00097511066","type":"CDM"},{"code":"57295","type":"HCPCS"}],"standard_charges":[{"gross_charge":1938.0,"discounted_cash":1453.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57410 PELVIC EXAMINATION","code_information":[{"code":"Px00097511069","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":306.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 57452 EXAM OF CERVIX W/SCOPE","code_information":[{"code":"Px00097511071","type":"CDM"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 57454 BX/CURETT OF CERVIX W/SCOPE","code_information":[{"code":"Px00097511072","type":"CDM"},{"code":"57454","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":486.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":649.0,"discounted_cash":486.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":515.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57460 BX OF CERVIX W/SCOPE LEEP","code_information":[{"code":"Px00097511073","type":"CDM"},{"code":"57460","type":"HCPCS"}],"standard_charges":[{"gross_charge":1183.0,"discounted_cash":887.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":616.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57522 CONIZATION OF CERVIX, LOOP ELECTRODE","code_information":[{"code":"Px00097511076","type":"CDM"},{"code":"57522","type":"HCPCS"}],"standard_charges":[{"gross_charge":1165.0,"discounted_cash":873.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1165.0,"discounted_cash":873.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":989.0,"discounted_cash":741.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58120 DILATION AND CURETTAGE","code_information":[{"code":"Px00097511079","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.0,"discounted_cash":858.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1144.0,"discounted_cash":858.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":902.0,"discounted_cash":676.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58145 MYOMECTOMY VAGINAL METHOD","code_information":[{"code":"Px00097511081","type":"CDM"},{"code":"58145","type":"HCPCS"}],"standard_charges":[{"gross_charge":2170.0,"discounted_cash":1627.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM","code_information":[{"code":"Px00097511083","type":"CDM"},{"code":"58150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3930.0,"discounted_cash":2947.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58180 PARTIAL HYSTERECTOMY","code_information":[{"code":"Px00097511086","type":"CDM"},{"code":"58180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3708.0,"discounted_cash":2781.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58260 VAGINAL HYSTERECTOMY","code_information":[{"code":"Px00097511088","type":"CDM"},{"code":"58260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3233.0,"discounted_cash":2424.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3233.0,"discounted_cash":2424.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58262 VAGINAL HYSTERECTOMY INCL TUBES/OVARY(S)","code_information":[{"code":"Px00097511089","type":"CDM"},{"code":"58262","type":"HCPCS"}],"standard_charges":[{"gross_charge":3574.0,"discounted_cash":2680.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58270 VAGINAL HYSTERECTOMY W/ENTEROCELE REPAIR","code_information":[{"code":"Px00097511091","type":"CDM"},{"code":"58270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3446.0,"discounted_cash":2584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58353 ENDOMETRIAL ABLATION THERMAL","code_information":[{"code":"Px00097511096","type":"CDM"},{"code":"58353","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2535.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":890.0,"discounted_cash":667.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 58552 LAPARO-VAGINAL HYSTERECTOMY INCL TUBES/OVARY(S)","code_information":[{"code":"Px00097511100","type":"CDM"},{"code":"58552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3785.0,"discounted_cash":2838.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3785.0,"discounted_cash":2838.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 58558 HYSTEROSCOPY BIOPSY","code_information":[{"code":"Px00097511103","type":"CDM"},{"code":"58558","type":"HCPCS"}],"standard_charges":[{"gross_charge":4777.0,"discounted_cash":3582.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":4777.0,"discounted_cash":3582.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":888.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58561 HYSTEROSCOPY REMOVE MYOMA","code_information":[{"code":"Px00097511104","type":"CDM"},{"code":"58561","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.0,"discounted_cash":1027.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1370.0,"discounted_cash":1027.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58563 HYSTEROSCOPY ABLATION","code_information":[{"code":"Px00097511106","type":"CDM"},{"code":"58563","type":"HCPCS"}],"standard_charges":[{"gross_charge":7556.0,"discounted_cash":5667.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":942.0,"discounted_cash":706.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58611 LIGATE OVIDUCT(S) ADD-ON","code_information":[{"code":"Px00097511107","type":"CDM"},{"code":"58611","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58660 LAPAROSCOPY LYSIS","code_information":[{"code":"Px00097511109","type":"CDM"},{"code":"58660","type":"HCPCS"}],"standard_charges":[{"gross_charge":2650.0,"discounted_cash":1987.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2650.0,"discounted_cash":1987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58661 LAPAROSCOPY REMOVE ADNEXA","code_information":[{"code":"Px00097511110","type":"CDM"},{"code":"58661","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":1886.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2515.0,"discounted_cash":1886.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58662 LAPAROSCOPY EXCISE LESIONS","code_information":[{"code":"Px00097511111","type":"CDM"},{"code":"58662","type":"HCPCS"}],"standard_charges":[{"gross_charge":2752.0,"discounted_cash":2064.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2752.0,"discounted_cash":2064.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58670 LAPAROSCOPY TUBAL CAUTERY","code_information":[{"code":"Px00097511112","type":"CDM"},{"code":"58670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1077.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1436.0,"discounted_cash":1077.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58671 LAPAROSCOPY TUBAL BLOCK","code_information":[{"code":"Px00097511113","type":"CDM"},{"code":"58671","type":"HCPCS"}],"standard_charges":[{"gross_charge":1436.0,"discounted_cash":1077.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58720 REMOVAL OF OVARY/TUBE(S)","code_information":[{"code":"Px00097511116","type":"CDM"},{"code":"58720","type":"HCPCS"}],"standard_charges":[{"gross_charge":2939.0,"discounted_cash":2204.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58940 REMOVAL OF OVARY(S)","code_information":[{"code":"Px00097511117","type":"CDM"},{"code":"58940","type":"HCPCS"}],"standard_charges":[{"gross_charge":2150.0,"discounted_cash":1612.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 60220 PARTIAL REMOVAL OF THYROID, W/WO ISTHMUSECTOMY","code_information":[{"code":"Px00097511125","type":"CDM"},{"code":"60220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2739.0,"discounted_cash":2054.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 60240 REMOVAL OF THYROID","code_information":[{"code":"Px00097511127","type":"CDM"},{"code":"60240","type":"HCPCS"}],"standard_charges":[{"gross_charge":3546.0,"discounted_cash":2659.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 60252 REMOVAL OF THYROID FOR MALIGNANCY","code_information":[{"code":"Px00097511128","type":"CDM"},{"code":"60252","type":"HCPCS"}],"standard_charges":[{"gross_charge":5085.0,"discounted_cash":3813.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 60280 REMOVE THYROID DUCT CYST/SINUS","code_information":[{"code":"Px00097511133","type":"CDM"},{"code":"60280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.0,"discounted_cash":1326.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1769.0,"discounted_cash":1326.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 60300 ASPIR/INJ THYROID CYST","code_information":[{"code":"Px00097511135","type":"CDM"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":297.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 43245 EGD DILATE STRICTURE","code_information":[{"code":"Px00097511161","type":"CDM"},{"code":"43245","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":503.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44020 EXPLORE SMALL INTESTINE","code_information":[{"code":"Px00097511166","type":"CDM"},{"code":"44020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3768.0,"discounted_cash":2826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 44050 REDUCE BOWEL OBSTRUCTION","code_information":[{"code":"Px00097511169","type":"CDM"},{"code":"44050","type":"HCPCS"}],"standard_charges":[{"gross_charge":3620.0,"discounted_cash":2715.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64702 REVISE FINGER/TOE NERVE","code_information":[{"code":"Px00097511172","type":"CDM"},{"code":"64702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2024.0,"discounted_cash":1518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57461 CONZ OF CERVIX W/SCOPE LEEP","code_information":[{"code":"Px00097511184","type":"CDM"},{"code":"57461","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":993.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":704.0,"discounted_cash":528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57520 CONIZATION OF CERVIX COLD KNIFE OR LASER","code_information":[{"code":"Px00097511185","type":"CDM"},{"code":"57520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1359.0,"discounted_cash":1019.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 69222 CLEAN OUT MASTOID CAVITY COMPLEX","code_information":[{"code":"Px00097511188","type":"CDM"},{"code":"69222","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":617.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 69433 CREATE EARDRUM OPENING LOCAL ANESTHESIA","code_information":[{"code":"Px00097511198","type":"CDM"},{"code":"69433","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":579.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":773.0,"discounted_cash":579.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 58322 ARTIFICIAL INSEMINATION","code_information":[{"code":"Px00097511204","type":"CDM"},{"code":"58322","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":263.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 69610 REPAIR OF EARDRUM","code_information":[{"code":"Px00097511208","type":"CDM"},{"code":"69610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1471.0,"discounted_cash":1103.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 58554 LAPARO-VAGINAL HYSTERECTOMY W/ TUBES/OVARY(S) COMPLEX","code_information":[{"code":"Px00097511213","type":"CDM"},{"code":"58554","type":"HCPCS"}],"standard_charges":[{"gross_charge":5016.0,"discounted_cash":3762.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58562 HYSTEROSCOPY REMOVE FB","code_information":[{"code":"Px00097511216","type":"CDM"},{"code":"58562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.0,"discounted_cash":1173.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36589 REMOVAL TUNNELED CV CATH","code_information":[{"code":"Px00097511227","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":471.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":520.0,"discounted_cash":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25066 BIOPSY FOREARM SOFT TISSUES-DEEP","code_information":[{"code":"Px00097511229","type":"CDM"},{"code":"25066","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.0,"discounted_cash":1106.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC","code_information":[{"code":"Px00097511246","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":841.0,"discounted_cash":630.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":190.0,"discounted_cash":142.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43763 PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC","code_information":[{"code":"Px00097511247","type":"CDM"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":335.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00097511282","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":284.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":379.0,"discounted_cash":284.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":143.0,"discounted_cash":107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11103 TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00097511283","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":141.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":189.0,"discounted_cash":141.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":83.0,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER","code_information":[{"code":"Px00097511300","type":"CDM"},{"code":"23472","type":"HCPCS"}],"standard_charges":[{"gross_charge":5599.0,"discounted_cash":4199.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27385 SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY","code_information":[{"code":"Px00097511310","type":"CDM"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2380.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE","code_information":[{"code":"Px00097511311","type":"CDM"},{"code":"29826","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":494.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM","code_information":[{"code":"Px00097511312","type":"CDM"},{"code":"59400","type":"HCPCS"}],"standard_charges":[{"gross_charge":9321.0,"discounted_cash":6990.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59510 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM","code_information":[{"code":"Px00097511315","type":"CDM"},{"code":"59510","type":"HCPCS"}],"standard_charges":[{"gross_charge":10354.0,"discounted_cash":7765.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59812 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL","code_information":[{"code":"Px00097511317","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.0,"discounted_cash":895.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59514 CESAREAN DELIVERY ONLY","code_information":[{"code":"Px00097511320","type":"CDM"},{"code":"59514","type":"HCPCS"}],"standard_charges":[{"gross_charge":3483.0,"discounted_cash":2612.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24342 RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF","code_information":[{"code":"Px00097511321","type":"CDM"},{"code":"24342","type":"HCPCS"}],"standard_charges":[{"gross_charge":3035.0,"discounted_cash":2276.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26160 EXC LESION TDN SHTH/JT CAPSL HAND/FNGR","code_information":[{"code":"Px00097511324","type":"CDM"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT","code_information":[{"code":"Px00097511325","type":"CDM"},{"code":"27130","type":"HCPCS"}],"standard_charges":[{"gross_charge":4983.0,"discounted_cash":3737.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27236 OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT","code_information":[{"code":"Px00097511327","type":"CDM"},{"code":"27236","type":"HCPCS"}],"standard_charges":[{"gross_charge":4640.0,"discounted_cash":3480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS","code_information":[{"code":"Px00097511328","type":"CDM"},{"code":"27447","type":"HCPCS"}],"standard_charges":[{"gross_charge":4977.0,"discounted_cash":3732.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28124 PARTICAL EXCISION BONE PHALANX TOE","code_information":[{"code":"Px00097511343","type":"CDM"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":984.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28485 OPEN TREATMENT METATARSAL FRACTURE EACH","code_information":[{"code":"Px00097511344","type":"CDM"},{"code":"28485","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1650.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29880 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING","code_information":[{"code":"Px00097511348","type":"CDM"},{"code":"29880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2209.0,"discounted_cash":1656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59300 EPISIOTOMY/VAG RPR OTH/THN ATTENDING","code_information":[{"code":"Px00097511359","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59409 VAGINAL DELIVERY ONLY","code_information":[{"code":"Px00097511360","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3071.0,"discounted_cash":2303.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27266 CLTX POST HIP ARTHRP DISLC REQ ANES","code_information":[{"code":"Px00097511364","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23620 CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ","code_information":[{"code":"Px00097511372","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1056.0,"discounted_cash":792.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64718 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW","code_information":[{"code":"Px00097511373","type":"CDM"},{"code":"64718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2381.0,"discounted_cash":1785.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32554 THORANCENTESIS NEEDLE/CATH PLEURA W/O IMAGING","code_information":[{"code":"Px00097511404","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING","code_information":[{"code":"Px00097511405","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 50684 INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH CDM","code_information":[{"code":"Px00097511445","type":"CDM"},{"code":"50684","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51102 ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER CDM","code_information":[{"code":"Px00097511493","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":404.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 40806 INCISION OF LIP FOLD","code_information":[{"code":"Px00097511511","type":"CDM"},{"code":"40806","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":288.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 49905 OMENTAL FLAP EXTEA ABDOM","code_information":[{"code":"Px00097511522","type":"CDM"},{"code":"49905","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.0,"discounted_cash":1007.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25071 EXC TUMOR ARM/WRST 3CM","code_information":[{"code":"Px00097511530","type":"CDM"},{"code":"25071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1667.0,"discounted_cash":1250.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1667.0,"discounted_cash":1250.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25676 OPEN RADIOULNAR DISLOC","code_information":[{"code":"Px00097511531","type":"CDM"},{"code":"25676","type":"HCPCS"}],"standard_charges":[{"gross_charge":2487.0,"discounted_cash":1865.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 26536 ARTHPSTY INTPHL JNT IMP","code_information":[{"code":"Px00097511532","type":"CDM"},{"code":"26536","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.0,"discounted_cash":2179.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27134 REV TOTAL HIP ARTHRO","code_information":[{"code":"Px00097511535","type":"CDM"},{"code":"27134","type":"HCPCS"}],"standard_charges":[{"gross_charge":7355.0,"discounted_cash":5516.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20692 APPLY BONE FIXATION DEVICE","code_information":[{"code":"Px00097511730","type":"CDM"},{"code":"20692","type":"HCPCS"}],"standard_charges":[{"gross_charge":4410.0,"discounted_cash":3307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20985 CPTR-ASST DIR MS PX","code_information":[{"code":"Px00097511762","type":"CDM"},{"code":"20985","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 22015 &D ABSCESS P-SPINE L/S/LS","code_information":[{"code":"Px00097511933","type":"CDM"},{"code":"22015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3722.0,"discounted_cash":2791.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23474 REVIS RECONST SHOULDER JOINT","code_information":[{"code":"Px00097512015","type":"CDM"},{"code":"23474","type":"HCPCS"}],"standard_charges":[{"gross_charge":6716.0,"discounted_cash":5037.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 25073 EXC FOREARM TUM DEEP 3 CM/>","code_information":[{"code":"Px00097512038","type":"CDM"},{"code":"25073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2113.0,"discounted_cash":1584.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25215 REMOVAL OF WRIST BONES","code_information":[{"code":"Px00097512059","type":"CDM"},{"code":"25215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2449.0,"discounted_cash":1836.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25265 REPAIR FOREARM TENDON/MUSCLE CDM","code_information":[{"code":"Px00097512067","type":"CDM"},{"code":"25265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2964.0,"discounted_cash":2223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26235 PARTIAL REMOVAL FINGER BONE","code_information":[{"code":"Px00097512144","type":"CDM"},{"code":"26235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1952.0,"discounted_cash":1464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26320 REMOVAL OF IMPLANT FROM HAND","code_information":[{"code":"Px00097512149","type":"CDM"},{"code":"26320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.0,"discounted_cash":1043.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26445 RELEASE HAND/FINGER TENDON","code_information":[{"code":"Px00097512165","type":"CDM"},{"code":"26445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2337.0,"discounted_cash":1752.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26480 TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN CDM","code_information":[{"code":"Px00097512176","type":"CDM"},{"code":"26480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":2109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26502 HAND TENDON RECONSTRUCTION","code_information":[{"code":"Px00097512188","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":2930.0,"discounted_cash":2197.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26525 RELEASE FINGER CONTRACTURE","code_information":[{"code":"Px00097512195","type":"CDM"},{"code":"26525","type":"HCPCS"}],"standard_charges":[{"gross_charge":2648.0,"discounted_cash":1986.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26531 ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT","code_information":[{"code":"Px00097512197","type":"CDM"},{"code":"26531","type":"HCPCS"}],"standard_charges":[{"gross_charge":2501.0,"discounted_cash":1875.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26541 REPAIR HAND JOINT WITH GRAFT","code_information":[{"code":"Px00097512199","type":"CDM"},{"code":"26541","type":"HCPCS"}],"standard_charges":[{"gross_charge":3250.0,"discounted_cash":2437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27030 DRAINAGE OF HIP JOINT","code_information":[{"code":"Px00097512238","type":"CDM"},{"code":"27030","type":"HCPCS"}],"standard_charges":[{"gross_charge":3651.0,"discounted_cash":2738.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27138 REVISE HIP JOINT REPLACEMENT","code_information":[{"code":"Px00097512251","type":"CDM"},{"code":"27138","type":"HCPCS"}],"standard_charges":[{"gross_charge":5894.0,"discounted_cash":4420.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27187 REINFORCE HIP BONES","code_information":[{"code":"Px00097512252","type":"CDM"},{"code":"27187","type":"HCPCS"}],"standard_charges":[{"gross_charge":3889.0,"discounted_cash":2916.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27248 OPTX GREATER TROCHANTERIC FRACTURE CDM","code_information":[{"code":"Px00097512259","type":"CDM"},{"code":"27248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2908.0,"discounted_cash":2181.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27726 REPAIR FIBULA NONUNION","code_information":[{"code":"Px00097512313","type":"CDM"},{"code":"27726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3734.0,"discounted_cash":2800.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27769 OPTX POST ANKLE FX","code_information":[{"code":"Px00097512315","type":"CDM"},{"code":"27769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2845.0,"discounted_cash":2133.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28750 ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT CDM","code_information":[{"code":"Px00097512351","type":"CDM"},{"code":"28750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":1680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28755 ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT CDM","code_information":[{"code":"Px00097512352","type":"CDM"},{"code":"28755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":987.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29806 SHOULDER ARTHROSCOPY/SURGERY","code_information":[{"code":"Px00097512354","type":"CDM"},{"code":"29806","type":"HCPCS"}],"standard_charges":[{"gross_charge":4124.0,"discounted_cash":3093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 31579 DIAGNOSTIC LARYNGOSCOPY W/ STROBOSCOPE","code_information":[{"code":"Px00097512388","type":"CDM"},{"code":"31579","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":565.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 51720 BLADDER INSTILLATION ANTICARCINOGENIC AGENT CDM","code_information":[{"code":"Px00097512395","type":"CDM"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32552 REMOVE LUNG CATHETER","code_information":[{"code":"Px00097512454","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":524.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":699.0,"discounted_cash":524.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 38900 IO MAP OF SENT LYMPH NODE","code_information":[{"code":"Px00097512800","type":"CDM"},{"code":"38900","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":394.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 40814 EXCISE/REPAIR MOUTH LESION","code_information":[{"code":"Px00097512822","type":"CDM"},{"code":"40814","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"discounted_cash":1079.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 44227 LAP CLOSE ENTEROSTOMY","code_information":[{"code":"Px00097512937","type":"CDM"},{"code":"44227","type":"HCPCS"}],"standard_charges":[{"gross_charge":6344.0,"discounted_cash":4758.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 49441 PLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00097513025","type":"CDM"},{"code":"49441","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":687.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49450 REPLACE G/C TUBE PERC CDM","code_information":[{"code":"Px00097513027","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":246.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR 58573 TLH W/T/O UTERUS OVER 250 G","code_information":[{"code":"Px00097513096","type":"CDM"},{"code":"58573","type":"HCPCS"}],"standard_charges":[{"gross_charge":4695.0,"discounted_cash":3521.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 64418 NERVE BLOCK INJ SUPRASCAPULAR","code_information":[{"code":"Px00097513433","type":"CDM"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64566 NEUROELTRD STIM POST TIBIAL","code_information":[{"code":"Px00097513448","type":"CDM"},{"code":"64566","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64640 INJECTION TREATMENT OF NERVE","code_information":[{"code":"Px00097513471","type":"CDM"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":347.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52356 CYSTO/URETERO W/LITHOTRIPSY","code_information":[{"code":"Px00097513616","type":"CDM"},{"code":"52356","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.0,"discounted_cash":1182.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93268 ECG RECORD/REVIEW","code_information":[{"code":"Px00097513627","type":"CDM"},{"code":"93268","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":484.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58615 OCCLUDE FALLOPIAN TUBE BY DEVICE","code_information":[{"code":"Px00097513658","type":"CDM"},{"code":"58615","type":"HCPCS"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":731.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52005 CYSTO BLADDER W/URETERAL CATHETERIZATION CDM","code_information":[{"code":"Px00097513791","type":"CDM"},{"code":"52005","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":381.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52234 CYSTO W/REMOVAL OF TUMORS SMALL CDM","code_information":[{"code":"Px00097513795","type":"CDM"},{"code":"52234","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":700.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52317 LITHOLAPAXY SMPL/SM/LESS THAN 2.5 CM CDM","code_information":[{"code":"Px00097513814","type":"CDM"},{"code":"52317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52318 LITHOLAPAXY COMP/LG > 2.5 CM CDM","code_information":[{"code":"Px00097513815","type":"CDM"},{"code":"52318","type":"HCPCS"}],"standard_charges":[{"gross_charge":1795.0,"discounted_cash":1346.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52353 CYSTO W/URETEROSCOPY W/LITHOTRIPSY CDM","code_information":[{"code":"Px00097513826","type":"CDM"},{"code":"52353","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.0,"discounted_cash":1113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE CDM","code_information":[{"code":"Px00097513834","type":"CDM"},{"code":"52601","type":"HCPCS"}],"standard_charges":[{"gross_charge":2798.0,"discounted_cash":2098.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 52700 TRURL DRAINAGE PROSTATIC ABSCESS CDM","code_information":[{"code":"Px00097513839","type":"CDM"},{"code":"52700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":1284.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 54100 BIOPSY PENIS SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00097513891","type":"CDM"},{"code":"54100","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":352.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55100 DRAINAGE SCROTAL WALL ABSCESS CDM","code_information":[{"code":"Px00097513958","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":490.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH CDM","code_information":[{"code":"Px00097513974","type":"CDM"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":370.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55705 BIOPSY PROSTATE INCISIONAL ANY APPROACH CDM","code_information":[{"code":"Px00097513975","type":"CDM"},{"code":"55705","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":370.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE  CDM","code_information":[{"code":"Px00097513992","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":311.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE  CDM","code_information":[{"code":"Px00097513994","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10140 I&D HEMATOMA SEROMA/FLUID COLLECTION  CDM","code_information":[{"code":"Px00097513995","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":345.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00097513996","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":174.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11044 DEBRIDEMENT BONE 1ST 20 SQ CM/OR LESS CDM","code_information":[{"code":"Px00097513997","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":645.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11045 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM  CDM","code_information":[{"code":"Px00097513998","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11401 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM  CDM","code_information":[{"code":"Px00097514001","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL  CDM","code_information":[{"code":"Px00097514009","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM","code_information":[{"code":"Px00097514010","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":214.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<  CDM","code_information":[{"code":"Px00097514011","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":750.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1001.0,"discounted_cash":750.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":585.0,"discounted_cash":438.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","code_information":[{"code":"Px00097514013","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":754.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1006.0,"discounted_cash":754.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":563.0,"discounted_cash":422.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 19301 MASTECTOMY PARTIAL  CDM","code_information":[{"code":"Px00097514024","type":"CDM"},{"code":"19301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1920.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20525 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP  CD","code_information":[{"code":"Px00097514028","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1789.0,"discounted_cash":1341.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1789.0,"discounted_cash":1341.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":968.0,"discounted_cash":726.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS  CDM","code_information":[{"code":"Px00097514029","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23071 EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>  CDM","code_information":[{"code":"Px00097514035","type":"CDM"},{"code":"23071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":1236.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27337 EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>  CD","code_information":[{"code":"Px00097514041","type":"CDM"},{"code":"27337","type":"HCPCS"}],"standard_charges":[{"gross_charge":1647.0,"discounted_cash":1235.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>  CDM","code_information":[{"code":"Px00097514056","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36558 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>  CDM","code_information":[{"code":"Px00097514057","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":737.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36569 INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>  CDM","code_information":[{"code":"Px00097514058","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":360.0,"discounted_cash":270.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 43246 EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE  CDM","code_information":[{"code":"Px00097514068","type":"CDM"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 45915 RMVL FECAL IMPACTION/FB SPX UNDER ANES  CDM","code_information":[{"code":"Px00097514072","type":"CDM"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46040 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX  CDM","code_information":[{"code":"Px00097514073","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1672.0,"discounted_cash":1254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE  CDM","code_information":[{"code":"Px00097514078","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":302.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 56420 I&D OF BARTHOLINS GLAND ABSCESS  CDM","code_information":[{"code":"Px00097514088","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":318.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58555 HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE  CDM","code_information":[{"code":"Px00097514101","type":"CDM"},{"code":"58555","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":438.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC  CDM","code_information":[{"code":"Px00097514105","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT  CDM","code_information":[{"code":"Px00097514110","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 94060 SPIROMETRY PRE POST BRONCHODILATOR","code_information":[{"code":"Px00097610003","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 94729 DIFFUSING CAPACITY","code_information":[{"code":"Px00097610009","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":161.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 94200 MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ CDM","code_information":[{"code":"Px00097610012","type":"CDM"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 94010 SPIROMETRY","code_information":[{"code":"Px00097610016","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 94726 BODY PLETHYSMOGRAPHY","code_information":[{"code":"Px00097610027","type":"CDM"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR D0001 ATTORNEY CONSULT 15 MIN","code_information":[{"code":"Px00097810001","type":"CDM"},{"code":"D0001","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20606 DRAIN/INJ JOINT/BURSA INTERMEDIATE W/US CDM","code_information":[{"code":"Px00098100031","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":198.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36573 INSERTION PICC W/RS&I 5 YR/> CDM","code_information":[{"code":"Px00098100055","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":313.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 49450 REPLACE G/C TUBE PERC CDM","code_information":[{"code":"Px00098100066","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":246.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69205 CLEAR OUTER EAR CANAL W/ GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00098100080","type":"CDM"},{"code":"69205","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":365.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 15853 REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00098100097","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":43.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31622 DX BRONCHOSCOPE/WASH CDM","code_information":[{"code":"Px00098100121","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99408 ALCOHOL/DRUG SCREEN 15-30 MIN CDM","code_information":[{"code":"Px00098110003","type":"CDM"},{"code":"99408","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":120.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99409 ALCOHOL/DRUG SCREEN > 30 MIN CDM","code_information":[{"code":"Px00098110005","type":"CDM"},{"code":"99409","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99283 VISIT LOW MDM CDM","code_information":[{"code":"Px00098110009","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":202.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":270.0,"discounted_cash":202.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":358.0,"discounted_cash":268.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":270.0,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 99284 VISIT MODERATE MDM CDM","code_information":[{"code":"Px00098110012","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":345.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":461.0,"discounted_cash":345.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":611.0,"discounted_cash":458.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":461.0,"discounted_cash":345.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 99285 VISIT HIGH MDM CDM","code_information":[{"code":"Px00098110016","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":501.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":668.0,"discounted_cash":501.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":886.0,"discounted_cash":664.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":668.0,"discounted_cash":501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 92511 NASPHARYNGOSCOPY CDM","code_information":[{"code":"Px00098110018","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":332.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":443.0,"discounted_cash":332.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":194.0,"discounted_cash":145.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00098110021","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":788.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1051.0,"discounted_cash":788.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1080.0,"discounted_cash":810.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":814.0,"discounted_cash":610.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 99292 CRITICAL CARE ADDL 30 MIN CDM","code_information":[{"code":"Px00098110023","type":"CDM"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":342.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":457.0,"discounted_cash":342.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":540.0,"discounted_cash":405.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":407.0,"discounted_cash":305.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 33016 PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00098110030","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":877.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 33017 PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00098110031","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":923.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 33018 PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY CDM","code_information":[{"code":"Px00098110032","type":"CDM"},{"code":"33018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":1083.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 33019 PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00098110033","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":783.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92532 POSITIONAL NYSTAGMUS TEST CDM","code_information":[{"code":"Px00098110054","type":"CDM"},{"code":"92532","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 35226 REPAIR BLOOD VESSEL LESION, LOWER EXTREMITY CDM","code_information":[{"code":"Px00098110084","type":"CDM"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":3105.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42999 THROAT SURGERY PROCEDURE CDM","code_information":[{"code":"Px00098110089","type":"CDM"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":522.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 67715 CANTHOTOMY(SEPARATE PROCEDURE) CDM","code_information":[{"code":"Px00098110100","type":"CDM"},{"code":"67715","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":412.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92953 TEMP TRANSCUTANEOUS EXT PACING CDM","code_information":[{"code":"Px00098110101","type":"CDM"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":4.0,"discounted_cash":3.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":5.0,"discounted_cash":3.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM","code_information":[{"code":"Px00098110102","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":439.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":586.0,"discounted_cash":439.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":545.0,"discounted_cash":408.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 95992 CANALITH REPOSITIONING PROCEDURE CDM","code_information":[{"code":"Px00098110112","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":122.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":163.0,"discounted_cash":122.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":180.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23030 DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00098110113","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":993.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27197 CLOSED TX PELVIC RING FX W/O MANIP CDM","code_information":[{"code":"Px00098110141","type":"CDM"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":513.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27198 CLOSED TX PELVIC RING FX W/MANIP CDM","code_information":[{"code":"Px00098110142","type":"CDM"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":1630.0,"discounted_cash":1222.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 76706 US ABD AORTA SCRN AAA CDM","code_information":[{"code":"Px00098110143","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":407.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS/YOUNGER THAN 5YRS CDM","code_information":[{"code":"Px00098110144","type":"CDM"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":90.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99152 MOD SED SAME PHYS/QHP 5/>YRS 1ST 15 MIN CDM","code_information":[{"code":"Px00098110145","type":"CDM"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":192.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":61.0,"discounted_cash":45.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99153 MOD SED SAME PHYS/QHP EA ADDL 15 MIN CDM","code_information":[{"code":"Px00098110146","type":"CDM"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS/YOUNGER THAN 5YRS CDM","code_information":[{"code":"Px00098110147","type":"CDM"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":313.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99157 MOD SED OTHER PHYS/QHP EA ADDL 15 MIN CDM","code_information":[{"code":"Px00098110148","type":"CDM"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":217.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99156 MOD SED OTH PHYS/QHP 5/>YRS 1ST 15 MIN CDM","code_information":[{"code":"Px00098110149","type":"CDM"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00098110157","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":133.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36430 BLOOD TRANSFUSION SERVICE CDM","code_information":[{"code":"Px00098110223","type":"CDM"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":123.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":165.0,"discounted_cash":123.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 36555 INSJ NON-TUNNELED CENTRAL VENOUS CATH/YOUNGER THAN 5 YRS CDM","code_information":[{"code":"Px00098110224","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":528.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":705.0,"discounted_cash":528.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":423.0,"discounted_cash":317.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36680 INSERT NEEDLE BONE CAVITY CDM","code_information":[{"code":"Px00098110226","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":228.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":302.0,"discounted_cash":226.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM","code_information":[{"code":"Px00098110229","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":369.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":492.0,"discounted_cash":369.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":550.0,"discounted_cash":412.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM","code_information":[{"code":"Px00098110231","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":944.0,"discounted_cash":708.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":712.0,"discounted_cash":534.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 10080 DRAINAGE OF PILONIDAL CYST SIMPLE CDM","code_information":[{"code":"Px00098110232","type":"CDM"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":707.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":943.0,"discounted_cash":707.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":542.0,"discounted_cash":406.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10081 DRAINAGE OF PILONIDAL CYST COMPLICATED CDM","code_information":[{"code":"Px00098110233","type":"CDM"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":975.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1300.0,"discounted_cash":975.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":880.0,"discounted_cash":660.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM","code_information":[{"code":"Px00098110234","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":436.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":582.0,"discounted_cash":436.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":543.0,"discounted_cash":407.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10121 REMOVE FOREIGN BODY COMPLICATED CDM","code_information":[{"code":"Px00098110235","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1018.0,"discounted_cash":763.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1018.0,"discounted_cash":763.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":942.0,"discounted_cash":706.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":710.0,"discounted_cash":532.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 10140 DRAINAGE OF HEMATOMA/FLUID CDM","code_information":[{"code":"Px00098110236","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":489.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":652.0,"discounted_cash":489.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":611.0,"discounted_cash":458.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM","code_information":[{"code":"Px00098110238","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":375.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":500.0,"discounted_cash":375.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":498.0,"discounted_cash":373.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 10180 COMPLEX DRAINAGE WOUND CDM","code_information":[{"code":"Px00098110239","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":759.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1012.0,"discounted_cash":759.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":924.0,"discounted_cash":693.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11000 DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00098110240","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":225.0,"discounted_cash":168.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":136.0,"discounted_cash":102.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00098110242","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":495.0,"discounted_cash":371.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":309.0,"discounted_cash":231.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11044 DEBRIDEMENT BONE 1ST 20 SQ CM/OR LESS CDM","code_information":[{"code":"Px00098110244","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":894.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1192.0,"discounted_cash":894.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1143.0,"discounted_cash":857.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11045 DEB SUBQ TISSUE ADD-ON CDM","code_information":[{"code":"Px00098110245","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":152.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":126.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11046 DEB MUSC/FASCIA ADD-ON CDM","code_information":[{"code":"Px00098110246","type":"CDM"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":155.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 11401 EXC TR-EXT B9+MARG 0.6-1 CM CDM","code_information":[{"code":"Px00098110249","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":448.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":598.0,"discounted_cash":448.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":545.0,"discounted_cash":408.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11720 DEBRIDE NAIL 1-5 CDM","code_information":[{"code":"Px00098110250","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":95.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":127.0,"discounted_cash":95.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":73.0,"discounted_cash":54.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 11730 REMOVAL OF NAIL PLATE CDM","code_information":[{"code":"Px00098110251","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":328.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":438.0,"discounted_cash":328.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":273.0,"discounted_cash":204.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 11740 DRAIN BLOOD FROM UNDER NAIL CDM","code_information":[{"code":"Px00098110253","type":"CDM"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":221.0,"discounted_cash":165.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":168.0,"discounted_cash":126.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11750 REMOVAL OF NAIL BED CDM","code_information":[{"code":"Px00098110254","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":460.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":614.0,"discounted_cash":460.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":521.0,"discounted_cash":390.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11760 REPAIR OF NAIL BED CDM","code_information":[{"code":"Px00098110256","type":"CDM"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":531.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":708.0,"discounted_cash":531.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":560.0,"discounted_cash":420.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11765 EXCISION OF NAIL FOLD TOE CDM","code_information":[{"code":"Px00098110258","type":"CDM"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":474.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":632.0,"discounted_cash":474.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":479.0,"discounted_cash":359.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM","code_information":[{"code":"Px00098110259","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":270.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":361.0,"discounted_cash":270.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":228.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":172.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM","code_information":[{"code":"Px00098110260","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":329.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":439.0,"discounted_cash":329.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":299.0,"discounted_cash":224.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 12004 REPAIR SUPERFIC WOUND(S)7.6 TO 12.5CM SLP NK AX EXGEN T CDM","code_information":[{"code":"Px00098110261","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":383.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":511.0,"discounted_cash":383.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":372.0,"discounted_cash":279.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12005 REPAIR SUPERFIC WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN CDM","code_information":[{"code":"Px00098110262","type":"CDM"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":510.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":680.0,"discounted_cash":510.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":479.0,"discounted_cash":359.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12006 REPAIR SUPERFIC WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TR CDM","code_information":[{"code":"Px00098110263","type":"CDM"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":592.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":790.0,"discounted_cash":592.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":593.0,"discounted_cash":444.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12007 REPAIR SUPERFIC WOUND(S) >30CM SLP NK AX EXGEN TRNK EXT CDM","code_information":[{"code":"Px00098110264","type":"CDM"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":660.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":881.0,"discounted_cash":660.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":735.0,"discounted_cash":551.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM","code_information":[{"code":"Px00098110265","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12013 REPAIR SUPERFIC WOUND(S) 2.6 TO 5.0CM FACE ERS EYLD NSE CDM","code_information":[{"code":"Px00098110266","type":"CDM"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":336.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":449.0,"discounted_cash":336.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":294.0,"discounted_cash":220.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 12014 REPAIR SUPERFIC WOUND(S) 5.1 TO 7.5CM FACE ERS EYLD NSE CDM","code_information":[{"code":"Px00098110267","type":"CDM"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":408.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":545.0,"discounted_cash":408.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":377.0,"discounted_cash":282.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12015 REPAIR SUPERFIC WOUND(S) 7.6 TO 12.5CM FACE ERS EYLD NS CDM","code_information":[{"code":"Px00098110268","type":"CDM"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":498.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":664.0,"discounted_cash":498.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":477.0,"discounted_cash":357.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12016 REPAIR SUPERFIC WOUND(S) 12.6 TO 20.0CM FACE ERS EYLD N CDM","code_information":[{"code":"Px00098110269","type":"CDM"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":636.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":849.0,"discounted_cash":636.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":647.0,"discounted_cash":485.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12017 REPAIR SUPERFIC WOUND(S) 20.1 TO 30.0CM FACE ERS EYLD N CDM","code_information":[{"code":"Px00098110270","type":"CDM"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":441.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":589.0,"discounted_cash":441.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":781.0,"discounted_cash":585.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12018 REPAIR SUPERFIC WOUND(S) >30.0 CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00098110271","type":"CDM"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":500.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":667.0,"discounted_cash":500.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":885.0,"discounted_cash":663.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12020 CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM","code_information":[{"code":"Px00098110272","type":"CDM"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1149.0,"discounted_cash":861.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1149.0,"discounted_cash":861.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":971.0,"discounted_cash":728.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12021 CLOSURE OF SPLIT WOUND W/PACKNG CDM","code_information":[{"code":"Px00098110273","type":"CDM"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":508.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":678.0,"discounted_cash":508.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":722.0,"discounted_cash":541.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM","code_information":[{"code":"Px00098110274","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":750.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1001.0,"discounted_cash":750.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":776.0,"discounted_cash":582.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12032 INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00098110275","type":"CDM"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":873.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1164.0,"discounted_cash":873.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":976.0,"discounted_cash":732.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12034 INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00098110276","type":"CDM"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":959.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1279.0,"discounted_cash":959.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1051.0,"discounted_cash":788.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12035 INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110277","type":"CDM"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1495.0,"discounted_cash":1121.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1495.0,"discounted_cash":1121.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1240.0,"discounted_cash":930.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12036 INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00098110278","type":"CDM"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1254.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1673.0,"discounted_cash":1254.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1450.0,"discounted_cash":1087.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12037 INTMD WND REPAIR S/TR/EXT > 30 CM. CDM","code_information":[{"code":"Px00098110279","type":"CDM"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":1407.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1876.0,"discounted_cash":1407.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1679.0,"discounted_cash":1259.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12041 INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM","code_information":[{"code":"Px00098110280","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":754.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1006.0,"discounted_cash":754.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":747.0,"discounted_cash":560.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00098110281","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":888.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1185.0,"discounted_cash":888.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1004.0,"discounted_cash":753.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12044 INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00098110282","type":"CDM"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1466.0,"discounted_cash":1099.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1466.0,"discounted_cash":1099.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1102.0,"discounted_cash":826.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12045 INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110284","type":"CDM"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1585.0,"discounted_cash":1188.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1585.0,"discounted_cash":1188.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1397.0,"discounted_cash":1047.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12046 INTMD WND REPAIR N-HG/GENIT 20.1-30.0CM CDM","code_information":[{"code":"Px00098110285","type":"CDM"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1924.0,"discounted_cash":1443.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1924.0,"discounted_cash":1443.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1637.0,"discounted_cash":1227.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12047 INTMD WND REPAIR N-HG/GENIT >30.0CM CDM","code_information":[{"code":"Px00098110286","type":"CDM"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1581.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2109.0,"discounted_cash":1581.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1813.0,"discounted_cash":1359.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/OR LESS CDM","code_information":[{"code":"Px00098110287","type":"CDM"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":809.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1079.0,"discounted_cash":809.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":866.0,"discounted_cash":649.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM","code_information":[{"code":"Px00098110288","type":"CDM"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1206.0,"discounted_cash":904.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1206.0,"discounted_cash":904.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1022.0,"discounted_cash":766.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM","code_information":[{"code":"Px00098110289","type":"CDM"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":1039.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1386.0,"discounted_cash":1039.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1102.0,"discounted_cash":826.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12054 INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM","code_information":[{"code":"Px00098110290","type":"CDM"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":1094.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1459.0,"discounted_cash":1094.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1126.0,"discounted_cash":844.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12055 INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110291","type":"CDM"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1921.0,"discounted_cash":1440.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1921.0,"discounted_cash":1440.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1543.0,"discounted_cash":1157.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12057 INTMD WND REPAIR FACE/MM >30CM CDM","code_information":[{"code":"Px00098110293","type":"CDM"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":2321.0,"discounted_cash":1740.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2321.0,"discounted_cash":1740.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2156.0,"discounted_cash":1617.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13100 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110294","type":"CDM"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":974.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1299.0,"discounted_cash":974.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1026.0,"discounted_cash":769.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110295","type":"CDM"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1509.0,"discounted_cash":1131.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1509.0,"discounted_cash":1131.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1257.0,"discounted_cash":942.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13102 REPAIR WOUND/LESION ADD-ON EA ADD 5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110296","type":"CDM"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":333.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":444.0,"discounted_cash":333.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":363.0,"discounted_cash":272.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CPLX SCLP ARM L CDM","code_information":[{"code":"Px00098110297","type":"CDM"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.0,"discounted_cash":1014.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1353.0,"discounted_cash":1014.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1177.0,"discounted_cash":882.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":887.0,"discounted_cash":665.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX SCLP ARM L CDM","code_information":[{"code":"Px00098110298","type":"CDM"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.0,"discounted_cash":1215.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1620.0,"discounted_cash":1215.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1316.0,"discounted_cash":987.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/OR LESS CDM","code_information":[{"code":"Px00098110299","type":"CDM"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":362.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":483.0,"discounted_cash":362.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":416.0,"discounted_cash":312.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99080 SPECIAL REPORTS OR FORMS CDM","code_information":[{"code":"Px00098110307","type":"CDM"},{"code":"99080","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":49.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30000 DRAINAGE OF NOSE LESION CDM","code_information":[{"code":"Px00098110314","type":"CDM"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":759.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":630.0,"discounted_cash":472.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30300 REMOVE NASAL FOREIGN BODY CDM","code_information":[{"code":"Px00098110316","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":595.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":794.0,"discounted_cash":595.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":621.0,"discounted_cash":465.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30901 CONTROL OF NOSEBLEED SIMPLE CDM","code_information":[{"code":"Px00098110317","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":448.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":598.0,"discounted_cash":448.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":287.0,"discounted_cash":215.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30903 CONTROL OF NOSEBLEED COMPLEX CDM","code_information":[{"code":"Px00098110319","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":693.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":924.0,"discounted_cash":693.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":394.0,"discounted_cash":295.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30905 CONTROL OF NOSEBLEED POSTERIOR CDM","code_information":[{"code":"Px00098110321","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1326.0,"discounted_cash":994.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":542.0,"discounted_cash":406.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 30906 REPEAT CONTROL OF NOSEBLEED CDM","code_information":[{"code":"Px00098110322","type":"CDM"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":1444.0,"discounted_cash":1083.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1444.0,"discounted_cash":1083.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":672.0,"discounted_cash":504.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31231 NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00098110323","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":546.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":728.0,"discounted_cash":546.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 31500 INS EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00098110324","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":405.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":541.0,"discounted_cash":405.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":718.0,"discounted_cash":538.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31502 CHANGE OF WINDPIPE AIRWAY CDM","code_information":[{"code":"Px00098110325","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":132.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":175.0,"discounted_cash":131.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31505 DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00098110326","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31511 REMOVE FOREIGN BODY LARYNX CDM","code_information":[{"code":"Px00098110328","type":"CDM"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":513.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31515 LARYNGOSCOPY FOR ASPIRATION CDM","code_information":[{"code":"Px00098110329","type":"CDM"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":426.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31520 DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00098110330","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":600.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31525 DX LARYNGOSCOPY EXCL NEWBORN CDM","code_information":[{"code":"Px00098110331","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":612.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31530 LARYNGOSCOPY W/FB REMOVAL CDM","code_information":[{"code":"Px00098110332","type":"CDM"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":572.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":763.0,"discounted_cash":572.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1012.0,"discounted_cash":759.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31575 DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00098110333","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":367.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":490.0,"discounted_cash":367.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":355.0,"discounted_cash":266.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31577 REMOVE FOREIGN BODY LARYNX FLEXIBLE FIBEROPTIC CDM","code_information":[{"code":"Px00098110334","type":"CDM"},{"code":"31577","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":512.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31603 TRACHEOSTOMY CDM","code_information":[{"code":"Px00098110335","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.0,"discounted_cash":912.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1217.0,"discounted_cash":912.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1615.0,"discounted_cash":1211.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 31605 CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00098110336","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":947.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1263.0,"discounted_cash":947.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1676.0,"discounted_cash":1257.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32110 EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00098110337","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":7497.0,"discounted_cash":5622.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32160 OPEN CHEST HEART MASSAGE CDM","code_information":[{"code":"Px00098110338","type":"CDM"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4072.0,"discounted_cash":3054.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32551 INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00098110342","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":442.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":590.0,"discounted_cash":442.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":783.0,"discounted_cash":587.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":590.0,"discounted_cash":442.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 33210 INSERTION OF HEART ELECTRODE CDM","code_information":[{"code":"Px00098110346","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":455.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":607.0,"discounted_cash":455.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":805.0,"discounted_cash":603.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36000 PLACE NEEDLE IN VEIN CDM","code_information":[{"code":"Px00098110348","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":34.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40650 REPAIR LIP, FULL THICKNESS VERMILION ONLY CDM","code_information":[{"code":"Px00098110349","type":"CDM"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1652.0,"discounted_cash":1239.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40654 REPAIR LIP FULL THICKNESS OVER ONE-HALF VERTICAL HEIGHT CDM","code_information":[{"code":"Px00098110351","type":"CDM"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1659.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40800 DRAINAGE OF MOUTH LESION, SIMPLE CDM","code_information":[{"code":"Px00098110352","type":"CDM"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":587.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":783.0,"discounted_cash":587.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":620.0,"discounted_cash":465.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40804 REMOVAL FOREIGN BODY MOUTH, SIMPLE CDM","code_information":[{"code":"Px00098110353","type":"CDM"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":457.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40830 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/OR LESS CDM","code_information":[{"code":"Px00098110354","type":"CDM"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":567.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 40831 REPAIR MOUTH LACERATION >2.5CM CDM","code_information":[{"code":"Px00098110355","type":"CDM"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":859.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1146.0,"discounted_cash":859.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1044.0,"discounted_cash":783.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41000 DRAINAGE OF MOUTH LESION, LINGUAL CDM","code_information":[{"code":"Px00098110356","type":"CDM"},{"code":"41000","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":414.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41250 RPR LAC LTE 2.5 CM MOUTH &/ ANT TWO-THIRDS TONGUE CDM","code_information":[{"code":"Px00098110357","type":"CDM"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":816.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1088.0,"discounted_cash":816.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":795.0,"discounted_cash":596.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41251 RPR LAC LTE 2.5 CM POSTERIOR ONE-THIRD TONGUE CDM","code_information":[{"code":"Px00098110358","type":"CDM"},{"code":"41251","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":709.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41252 REPAIR OF LACER OF TONGUE FLOOR OF MOUTH >2.6 C CDM","code_information":[{"code":"Px00098110359","type":"CDM"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":806.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 41800 DRAINAGE OF GUM LESION CDM","code_information":[{"code":"Px00098110360","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":612.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42000 DRAINAGE MOUTH ROOF LESION CDM","code_information":[{"code":"Px00098110361","type":"CDM"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":423.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42180 REPAIR, LACERATION OF PALATE UP TO 2 CM CDM","code_information":[{"code":"Px00098110362","type":"CDM"},{"code":"42180","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":726.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42182 REPAIR, LACERATION OF PALATE OVER 2 CM OR COMPLEX CDM","code_information":[{"code":"Px00098110363","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":996.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42300 DRAINAGE OF SALIVARY GLAND, SIMPLE CDM","code_information":[{"code":"Px00098110364","type":"CDM"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":807.0,"discounted_cash":605.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42310 DRAINAGE OF SALIVARY GLAND, SUBLINGUAL CDM","code_information":[{"code":"Px00098110365","type":"CDM"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":493.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":658.0,"discounted_cash":493.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":698.0,"discounted_cash":523.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42700 DRAINAGE OF TONSIL ABSCESS CDM","code_information":[{"code":"Px00098110366","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":555.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":740.0,"discounted_cash":555.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":705.0,"discounted_cash":528.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42809 REMOVE PHARYNX FOREIGN BODY CDM","code_information":[{"code":"Px00098110368","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":486.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42960 CONTROL THROAT BLEEDING, SIMPLE CDM","code_information":[{"code":"Px00098110372","type":"CDM"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":470.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":627.0,"discounted_cash":470.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":832.0,"discounted_cash":624.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 42970 CONTROL NOSE/THROAT BLEEDING CDM","code_information":[{"code":"Px00098110373","type":"CDM"},{"code":"42970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.0,"discounted_cash":1589.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 43753 TX GASTRO INTUB W/ASP CDM","code_information":[{"code":"Px00098110375","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":82.0,"discounted_cash":61.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 45005 DRAINAGE OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00098110377","type":"CDM"},{"code":"45005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1225.0,"discounted_cash":918.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1225.0,"discounted_cash":918.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 45300 PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00098110378","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":372.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":497.0,"discounted_cash":372.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":248.0,"discounted_cash":186.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 45307 PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00098110379","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":607.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":810.0,"discounted_cash":607.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":516.0,"discounted_cash":387.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 45915 REMOVE RECTAL OBSTRUCTION W GEN ANESTH CDM","code_information":[{"code":"Px00098110380","type":"CDM"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":1368.0,"discounted_cash":1026.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1368.0,"discounted_cash":1026.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1184.0,"discounted_cash":888.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":892.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 46040 INCISION OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00098110381","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2159.0,"discounted_cash":1619.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2159.0,"discounted_cash":1619.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2218.0,"discounted_cash":1663.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46050 INCISION OF ANAL ABSCESS CDM","code_information":[{"code":"Px00098110382","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":675.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":901.0,"discounted_cash":675.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":526.0,"discounted_cash":394.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46083 INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00098110383","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":595.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":794.0,"discounted_cash":595.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":571.0,"discounted_cash":428.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":430.0,"discounted_cash":322.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 46221 LIGATION OF HEMORRHOID(S) CDM","code_information":[{"code":"Px00098110384","type":"CDM"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1000.0,"discounted_cash":750.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46230 REMOVAL OF ANAL TAGS CDM","code_information":[{"code":"Px00098110385","type":"CDM"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1198.0,"discounted_cash":898.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1198.0,"discounted_cash":898.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 46320 REMOVAL OF HEMORRHOID CLOT CDM","code_information":[{"code":"Px00098110386","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":610.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":814.0,"discounted_cash":610.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":584.0,"discounted_cash":438.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46600 DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00098110387","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":329.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":439.0,"discounted_cash":329.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 46614 ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00098110389","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":475.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":634.0,"discounted_cash":475.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":331.0,"discounted_cash":248.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51102 DRAIN BL W/CATH INSERTION CDM","code_information":[{"code":"Px00098110394","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":536.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51700 IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00098110395","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":218.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":291.0,"discounted_cash":218.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":151.0,"discounted_cash":113.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51702 INSERT TEMP BLADDER CATHETER CDM","code_information":[{"code":"Px00098110396","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 51703 INSERT BLADDER CATHETER COMPLEX CDM","code_information":[{"code":"Px00098110397","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":425.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":567.0,"discounted_cash":425.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":385.0,"discounted_cash":288.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM","code_information":[{"code":"Px00098110398","type":"CDM"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":513.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 55100 DRAINAGE OF SCROTUM ABSCESS CDM","code_information":[{"code":"Px00098110399","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.0,"discounted_cash":669.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":892.0,"discounted_cash":669.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":868.0,"discounted_cash":651.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 55120 REMOVAL OF SCROTUM LESION CDM","code_information":[{"code":"Px00098110400","type":"CDM"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.0,"discounted_cash":1375.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110402","type":"CDM"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":947.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1263.0,"discounted_cash":947.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1533.0,"discounted_cash":1149.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1156.0,"discounted_cash":867.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27788 CLOSED TREATMENT OF ANKLE FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110405","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1533.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27808 TREATMENT OF ANKLE FRACTURE BIMAL W/O MANIP CDM","code_information":[{"code":"Px00098110406","type":"CDM"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1361.0,"discounted_cash":1020.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1361.0,"discounted_cash":1020.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1642.0,"discounted_cash":1231.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1238.0,"discounted_cash":928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27810 TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110409","type":"CDM"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1426.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1902.0,"discounted_cash":1426.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2269.0,"discounted_cash":1701.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1710.0,"discounted_cash":1282.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION CDM","code_information":[{"code":"Px00098110410","type":"CDM"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1340.0,"discounted_cash":1005.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1340.0,"discounted_cash":1005.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1579.0,"discounted_cash":1184.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27818 CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM","code_information":[{"code":"Px00098110413","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":2333.0,"discounted_cash":1749.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27824 CLOSED TREAT LOWER LEG FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110414","type":"CDM"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":1274.0,"discounted_cash":955.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1274.0,"discounted_cash":955.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1637.0,"discounted_cash":1227.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27830 CLOSED TREAT PROX TIB/FIB DISLOC CDM","code_information":[{"code":"Px00098110415","type":"CDM"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":1445.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27840 CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110417","type":"CDM"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1548.0,"discounted_cash":1161.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1548.0,"discounted_cash":1161.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2053.0,"discounted_cash":1539.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27842 CLOSED TREAT ANKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110418","type":"CDM"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":1949.0,"discounted_cash":1461.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1949.0,"discounted_cash":1461.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2586.0,"discounted_cash":1939.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28192 REMOVAL OF FOOT FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00098110419","type":"CDM"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.0,"discounted_cash":1317.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1756.0,"discounted_cash":1317.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1613.0,"discounted_cash":1209.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28193 REMOVAL OF FOOT FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00098110420","type":"CDM"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":1885.0,"discounted_cash":1413.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28208 REPAIR OF FOOT TENDON EXTENSOR TENDON CDM","code_information":[{"code":"Px00098110422","type":"CDM"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1848.0,"discounted_cash":1386.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1848.0,"discounted_cash":1386.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1664.0,"discounted_cash":1248.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28400 TREATMENT OF HEEL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110424","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.0,"discounted_cash":744.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":993.0,"discounted_cash":744.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1224.0,"discounted_cash":918.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28405 TREATMENT OF HEEL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110426","type":"CDM"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2160.0,"discounted_cash":1620.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28430 TREATMENT OF TALUS FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110429","type":"CDM"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.0,"discounted_cash":722.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":963.0,"discounted_cash":722.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1124.0,"discounted_cash":843.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":847.0,"discounted_cash":635.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 29700 REMOV BIVAL GAUN BOOT/BODY CAST CDM","code_information":[{"code":"Px00098110430","type":"CDM"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":127.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28435 TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110431","type":"CDM"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.0,"discounted_cash":1314.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28450 TREAT MIDFOOT FRACTURE EACH W/O MANIPULATION CDM","code_information":[{"code":"Px00098110432","type":"CDM"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":635.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":847.0,"discounted_cash":635.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1019.0,"discounted_cash":764.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":768.0,"discounted_cash":576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 28455 TREAT MIDFOOT FRACTURE EACH W/MANIPULATION CDM","code_information":[{"code":"Px00098110434","type":"CDM"},{"code":"28455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":903.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28470 TREAT METATARSAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110436","type":"CDM"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":654.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":872.0,"discounted_cash":654.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1092.0,"discounted_cash":819.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28475 CLOSED TREAT METATARSAL FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110438","type":"CDM"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":778.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1038.0,"discounted_cash":778.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1212.0,"discounted_cash":909.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28490 CLOSED TREAT BIG TOE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110440","type":"CDM"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":428.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":571.0,"discounted_cash":428.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":667.0,"discounted_cash":500.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28495 TREAT BIG TOE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110443","type":"CDM"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":598.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28510 TREATMENT OF TOE FRACTURE PHALANX CDM","code_information":[{"code":"Px00098110445","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":645.0,"discounted_cash":483.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":486.0,"discounted_cash":364.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP CDM","code_information":[{"code":"Px00098110448","type":"CDM"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":491.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":655.0,"discounted_cash":491.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":761.0,"discounted_cash":570.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28525 OPEN TREAT TOE FRACTURE PHALANX CDM","code_information":[{"code":"Px00098110449","type":"CDM"},{"code":"28525","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.0,"discounted_cash":1569.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28530 TREAT SESAMOID BONE FRACTURE CDM","code_information":[{"code":"Px00098110450","type":"CDM"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":355.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":474.0,"discounted_cash":355.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 28540 CLOSED TREAT TARSAL DISLOCATION CDM","code_information":[{"code":"Px00098110452","type":"CDM"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":698.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28545 TREAT FOOT DISLOCATION W/O MANIPULATION CDM","code_information":[{"code":"Px00098110453","type":"CDM"},{"code":"28545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":1089.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28570 TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00098110455","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":1065.0,"discounted_cash":798.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28575 TREAT FOOT DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110456","type":"CDM"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1522.0,"discounted_cash":1141.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1522.0,"discounted_cash":1141.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1812.0,"discounted_cash":1359.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28630 TREAT METATARSOPHAL DISLOCATION CDM","code_information":[{"code":"Px00098110460","type":"CDM"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":432.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28660 CLOSED TREAT TOE DISLOCATION CDM","code_information":[{"code":"Px00098110462","type":"CDM"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":373.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":498.0,"discounted_cash":373.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":491.0,"discounted_cash":368.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28665 TREAT TOE DISLOCATION W/ANETH CDM","code_information":[{"code":"Px00098110464","type":"CDM"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":442.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":590.0,"discounted_cash":442.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":652.0,"discounted_cash":489.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29065 LONG ARM CAST APPLICATION CDM","code_information":[{"code":"Px00098110466","type":"CDM"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":290.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":387.0,"discounted_cash":290.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":353.0,"discounted_cash":264.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM","code_information":[{"code":"Px00098110467","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":264.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":352.0,"discounted_cash":264.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":328.0,"discounted_cash":246.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 29105 LONG ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110468","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":246.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":329.0,"discounted_cash":246.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110469","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":199.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":266.0,"discounted_cash":199.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":209.0,"discounted_cash":156.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 29126 APPLY FOREARM SPLINT DYN CDM","code_information":[{"code":"Px00098110470","type":"CDM"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":235.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":314.0,"discounted_cash":235.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 29405 SHORT LEG CAST APPLICATION CDM","code_information":[{"code":"Px00098110476","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":320.0,"discounted_cash":240.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":304.0,"discounted_cash":228.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":229.0,"discounted_cash":171.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 29425 APPLY SHORT WALKING LEG CAST CDM","code_information":[{"code":"Px00098110477","type":"CDM"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":300.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":280.0,"discounted_cash":210.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29505 APPLICATION LONG LEG SPLINT CDM","code_information":[{"code":"Px00098110479","type":"CDM"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":271.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":362.0,"discounted_cash":271.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":273.0,"discounted_cash":204.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110480","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":216.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":289.0,"discounted_cash":216.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":258.0,"discounted_cash":193.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 29540 STRAPPING OF ANKLE AND/OR FT CDM","code_information":[{"code":"Px00098110481","type":"CDM"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 29580 APPLICATION OF UNABOOT CDM","code_information":[{"code":"Px00098110482","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 29705 REMOVE OR BIVALVE CAST-FULL ARM OR LEG CDM","code_information":[{"code":"Px00098110483","type":"CDM"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":252.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":231.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29730 WINDOWING OF CAST CDM","code_information":[{"code":"Px00098110484","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28190 REMOVAL OF FOOT FOREIGN BODY CDM","code_information":[{"code":"Px00098110485","type":"CDM"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":682.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":910.0,"discounted_cash":682.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":683.0,"discounted_cash":512.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29345 APPLICATION/LONG LEG CAST CDM","code_information":[{"code":"Px00098110486","type":"CDM"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":403.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":538.0,"discounted_cash":403.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":513.0,"discounted_cash":384.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM","code_information":[{"code":"Px00098110489","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":160.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 36010 PLACE CATHETER IN VEIN CDM","code_information":[{"code":"Px00098110492","type":"CDM"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1946.0,"discounted_cash":1459.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1946.0,"discounted_cash":1459.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 36556 INSERT NON-TUNNEL CV CATH > 5 CDM","code_information":[{"code":"Px00098110494","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":597.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":796.0,"discounted_cash":597.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":423.0,"discounted_cash":317.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36558 INSERT TUNNELED CV CATH > 5 CDM","code_information":[{"code":"Px00098110495","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":3018.0,"discounted_cash":2263.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3018.0,"discounted_cash":2263.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1304.0,"discounted_cash":978.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36569 INSERTION PICC W/O IMG GDN 5 YR/> CDM","code_information":[{"code":"Px00098110496","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":360.0,"discounted_cash":270.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":477.0,"discounted_cash":357.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36620 INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00098110499","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":123.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":165.0,"discounted_cash":123.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":219.0,"discounted_cash":164.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36625 INSERT CATH ARTERY CUTDOWN CDM","code_information":[{"code":"Px00098110500","type":"CDM"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":397.0,"discounted_cash":297.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":526.0,"discounted_cash":394.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13131 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CPLX FRHD CKS SHN CDM","code_information":[{"code":"Px00098110501","type":"CDM"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":1111.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1482.0,"discounted_cash":1111.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1236.0,"discounted_cash":927.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":932.0,"discounted_cash":699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX FRHD CKS SHN CDM","code_information":[{"code":"Px00098110502","type":"CDM"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1795.0,"discounted_cash":1346.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1795.0,"discounted_cash":1346.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1538.0,"discounted_cash":1153.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13133 REPAIR WOUND/LESION ADD ON 5CM CMPLX FRHD CKS SHN MTH NK CDM","code_information":[{"code":"Px00098110503","type":"CDM"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":483.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":644.0,"discounted_cash":483.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":633.0,"discounted_cash":474.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13151 REPAIR OF WND OR LESN 1.1 TO 2.5CM CMPLX EYLD NS ERS LPS CDM","code_information":[{"code":"Px00098110505","type":"CDM"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1615.0,"discounted_cash":1211.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1615.0,"discounted_cash":1211.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1418.0,"discounted_cash":1063.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 13152 REPAIR OF WND OR LES 2.6 TO 7.5CM CMPLX EYLD NS ERS LPS CDM","code_information":[{"code":"Px00098110506","type":"CDM"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.0,"discounted_cash":1419.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1893.0,"discounted_cash":1419.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1703.0,"discounted_cash":1277.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16000 INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX CDM","code_information":[{"code":"Px00098110509","type":"CDM"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":232.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":310.0,"discounted_cash":232.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":233.0,"discounted_cash":174.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL CDM","code_information":[{"code":"Px00098110510","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":247.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":330.0,"discounted_cash":247.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":287.0,"discounted_cash":215.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM","code_information":[{"code":"Px00098110511","type":"CDM"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":451.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":602.0,"discounted_cash":451.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":567.0,"discounted_cash":425.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16030 DRESS/DEBRID P-THICK BURN L >10% TBSA CDM","code_information":[{"code":"Px00098110512","type":"CDM"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":575.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":767.0,"discounted_cash":575.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":679.0,"discounted_cash":509.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 16035 INCISION OF BURN SCAB INITI CDM","code_information":[{"code":"Px00098110513","type":"CDM"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":561.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":749.0,"discounted_cash":561.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 19000 DRAINAGE OF BREAST LESION CDM","code_information":[{"code":"Px00098110514","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":279.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":372.0,"discounted_cash":279.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":216.0,"discounted_cash":162.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20100 EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00098110517","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1734.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2313.0,"discounted_cash":1734.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3068.0,"discounted_cash":2301.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20101 EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00098110518","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":2127.0,"discounted_cash":1595.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2127.0,"discounted_cash":1595.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1075.0,"discounted_cash":806.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20102 EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00098110519","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.0,"discounted_cash":1711.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2282.0,"discounted_cash":1711.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1314.0,"discounted_cash":985.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20103 EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00098110520","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":2153.0,"discounted_cash":1614.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2153.0,"discounted_cash":1614.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1769.0,"discounted_cash":1326.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20520 REMOVAL OF FOREIGN BODY MUSC, SIMP CDM","code_information":[{"code":"Px00098110521","type":"CDM"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":630.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":840.0,"discounted_cash":630.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":766.0,"discounted_cash":574.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20525 REMOVAL OF FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00098110522","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1789.0,"discounted_cash":1341.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1789.0,"discounted_cash":1341.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1284.0,"discounted_cash":963.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM","code_information":[{"code":"Px00098110523","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":224.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":199.0,"discounted_cash":149.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20551 INJ TENDON ORIGIN/INSERTION CDM","code_information":[{"code":"Px00098110524","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":221.0,"discounted_cash":165.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":195.0,"discounted_cash":146.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM","code_information":[{"code":"Px00098110525","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":150.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":201.0,"discounted_cash":150.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":185.0,"discounted_cash":138.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES CD","code_information":[{"code":"Px00098110526","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":174.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":232.0,"discounted_cash":174.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":211.0,"discounted_cash":158.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":159.0,"discounted_cash":119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM","code_information":[{"code":"Px00098110528","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":155.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":207.0,"discounted_cash":155.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":182.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":137.0,"discounted_cash":102.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM","code_information":[{"code":"Px00098110529","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":158.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":211.0,"discounted_cash":158.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":187.0,"discounted_cash":140.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM","code_information":[{"code":"Px00098110530","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":188.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":251.0,"discounted_cash":188.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":231.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM","code_information":[{"code":"Px00098110531","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":188.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":251.0,"discounted_cash":188.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":231.0,"discounted_cash":173.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 20950 FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00098110532","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":342.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21315 TREATMENT OF NOSE FRACTURE W/O STABILIZATION CDM","code_information":[{"code":"Px00098110534","type":"CDM"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":444.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":593.0,"discounted_cash":444.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":307.0,"discounted_cash":230.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21320 TREATMENT OF NOSE FRACTURE W/ STABILIZATION CDM","code_information":[{"code":"Px00098110535","type":"CDM"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":623.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":831.0,"discounted_cash":623.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21450 TREAT LOWER JAW FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110540","type":"CDM"},{"code":"21450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2267.0,"discounted_cash":1700.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2267.0,"discounted_cash":1700.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2454.0,"discounted_cash":1840.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21480 RESET DISLOCATED JAW UNCOMPLICATED CDM","code_information":[{"code":"Px00098110541","type":"CDM"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":401.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":535.0,"discounted_cash":401.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":161.0,"discounted_cash":120.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21820 TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00098110544","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":600.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 22310 TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00098110547","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1169.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23500 TREAT CLAVICLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110551","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":684.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":913.0,"discounted_cash":684.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1240.0,"discounted_cash":930.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":934.0,"discounted_cash":700.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 23505 TREAT CLAVICLE FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110553","type":"CDM"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1457.0,"discounted_cash":1092.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1457.0,"discounted_cash":1092.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1793.0,"discounted_cash":1344.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23540 TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MAN CDM","code_information":[{"code":"Px00098110558","type":"CDM"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.0,"discounted_cash":723.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":965.0,"discounted_cash":723.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1272.0,"discounted_cash":954.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23545 TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM","code_information":[{"code":"Px00098110559","type":"CDM"},{"code":"23545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":1304.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23570 TREAT SHOULDER BLADE FX W/O MANIP CDM","code_information":[{"code":"Px00098110561","type":"CDM"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":717.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":957.0,"discounted_cash":717.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 23600 TREAT HUMERUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110563","type":"CDM"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":1017.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1356.0,"discounted_cash":1017.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1705.0,"discounted_cash":1278.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23605 TREAT HUMERUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110564","type":"CDM"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1884.0,"discounted_cash":1413.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1884.0,"discounted_cash":1413.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2267.0,"discounted_cash":1700.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23620 TREAT HUMERUS FRACTURE TUBEROSITY W/O MAN CDM","code_information":[{"code":"Px00098110566","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1401.0,"discounted_cash":1050.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23625 TREAT HUMERUS FRACTURE TUBEROSITY W/MAN CDM","code_information":[{"code":"Px00098110568","type":"CDM"},{"code":"23625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1864.0,"discounted_cash":1398.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23650 TREAT SHOULDER DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110570","type":"CDM"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1350.0,"discounted_cash":1012.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1615.0,"discounted_cash":1211.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1217.0,"discounted_cash":912.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM","code_information":[{"code":"Px00098110572","type":"CDM"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1624.0,"discounted_cash":1218.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2155.0,"discounted_cash":1616.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ CDM","code_information":[{"code":"Px00098110574","type":"CDM"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.0,"discounted_cash":1599.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23930 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00098110577","type":"CDM"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":1035.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1380.0,"discounted_cash":1035.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1122.0,"discounted_cash":841.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 23931 DRAINAGE OF ARM BURSA CDM","code_information":[{"code":"Px00098110578","type":"CDM"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":864.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1153.0,"discounted_cash":864.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":839.0,"discounted_cash":629.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 12056 INTMD WND REPAIR FACE/MM 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00098110579","type":"CDM"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":2225.0,"discounted_cash":1668.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2225.0,"discounted_cash":1668.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1976.0,"discounted_cash":1482.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 11732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL CDM","code_information":[{"code":"Px00098110581","type":"CDM"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":93.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":125.0,"discounted_cash":93.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":85.0,"discounted_cash":63.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 21400 TREAT EYE SOCKET FRACTURE NON BLOWOUT W/O MANIPULATION CDM","code_information":[{"code":"Px00098110583","type":"CDM"},{"code":"21400","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":669.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36600 WITHDRAWAL OF ARTERIAL BLOOD CDM","code_information":[{"code":"Px00098110587","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":75.0,"discounted_cash":56.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36400 VNPNXR/YOUNGER THAN 3YRS PHY/QHP SKILL FEM/JUGLAR VEIN CDM","code_information":[{"code":"Px00098110589","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":105.0,"discounted_cash":78.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 36405 VNPNXR/YOUNGER THAN 3 YRS PHYS/QHP SKILL SCALP VEIN CDM","code_information":[{"code":"Px00098110590","type":"CDM"},{"code":"36405","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":56.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36410 NON-ROUTINE BL DRAW > 3 YRS CDM","code_information":[{"code":"Px00098110592","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":69.0,"discounted_cash":51.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":46.0,"discounted_cash":34.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36420 VENIPUNCTURE CUTDOWN YOUNGER THAN 1 YR CDM","code_information":[{"code":"Px00098110593","type":"CDM"},{"code":"36420","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":134.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":179.0,"discounted_cash":134.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":238.0,"discounted_cash":178.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36425 VEIN ACCESS CUTDOWN > 1 YR CDM","code_information":[{"code":"Px00098110594","type":"CDM"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":150.0,"discounted_cash":112.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":199.0,"discounted_cash":149.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 92950 CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00098110596","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":922.0,"discounted_cash":691.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 94150 VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE) CDM","code_information":[{"code":"Px00098110597","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":96.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 59300 EPISIOTOMY OR VAGINAL REPAIR CDM","code_information":[{"code":"Px00098110601","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":655.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":874.0,"discounted_cash":655.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":754.0,"discounted_cash":565.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 59409 VAGINAL DELIVERY CDM","code_information":[{"code":"Px00098110602","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3071.0,"discounted_cash":2303.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3071.0,"discounted_cash":2303.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":4074.0,"discounted_cash":3055.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":3071.0,"discounted_cash":2303.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 59414 DELIVER PLACENTA CDM","code_information":[{"code":"Px00098110603","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":261.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":349.0,"discounted_cash":261.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":464.0,"discounted_cash":348.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM","code_information":[{"code":"Px00098110604","type":"CDM"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":44.0,"discounted_cash":33.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":58.0,"discounted_cash":43.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 93005 ECG 12 LEAD TRACING ONLY CDM","code_information":[{"code":"Px00098110605","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36660 IV CATH UMBILICAL CDM","code_information":[{"code":"Px00098110607","type":"CDM"},{"code":"36660","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":255.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 37609 TEMPORAL ARTERY PROCEDURE CDM","code_information":[{"code":"Px00098110609","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.0,"discounted_cash":880.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1174.0,"discounted_cash":880.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1036.0,"discounted_cash":777.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":781.0,"discounted_cash":585.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 92977 DISSOLVE CLOT HEART VESSEL IV CDM","code_information":[{"code":"Px00098110612","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":213.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 93503 INSERT/PLACE HEART CATHETER CDM","code_information":[{"code":"Px00098110613","type":"CDM"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":247.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":330.0,"discounted_cash":247.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 36568 INSERTION PICC W/O IMG GUIDANCE/YOUNGER THAN 5 YRS CDM","code_information":[{"code":"Px00098110614","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":348.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANI CDM","code_information":[{"code":"Px00098110619","type":"CDM"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2337.0,"discounted_cash":1752.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2337.0,"discounted_cash":1752.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3101.0,"discounted_cash":2325.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANI CDM","code_information":[{"code":"Px00098110620","type":"CDM"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":3101.0,"discounted_cash":2325.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29530 STRAPPING OF KNEE CDM","code_information":[{"code":"Px00098110626","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":84.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":113.0,"discounted_cash":84.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 27240 TREAT THIGH FRACTURE, CLOSED CDM","code_information":[{"code":"Px00098110643","type":"CDM"},{"code":"27240","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.0,"discounted_cash":3712.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 90371 HEP B IG IM CDM","code_information":[{"code":"Px00098110644","type":"CDM"},{"code":"90371","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":121.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM","code_information":[{"code":"Px00098110645","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":60.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 24500 TREAT HUMERUS FX W/O MANIP CDM","code_information":[{"code":"Px00098110701","type":"CDM"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1469.0,"discounted_cash":1101.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1469.0,"discounted_cash":1101.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1795.0,"discounted_cash":1346.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24505 TREAT HUMERUS FX W/MANIP CDM","code_information":[{"code":"Px00098110703","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.0,"discounted_cash":1515.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2021.0,"discounted_cash":1515.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2398.0,"discounted_cash":1798.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24530 TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00098110704","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":1162.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1550.0,"discounted_cash":1162.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1881.0,"discounted_cash":1410.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1418.0,"discounted_cash":1063.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 24535 TREAT HUMERUS FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110706","type":"CDM"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2487.0,"discounted_cash":1865.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2487.0,"discounted_cash":1865.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3028.0,"discounted_cash":2271.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24560 TREAT HUMERUS EPICOND FRACTURE CDM","code_information":[{"code":"Px00098110707","type":"CDM"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":1011.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1349.0,"discounted_cash":1011.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1586.0,"discounted_cash":1189.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24576 TREAT HUMERUS CONDYLAR FRACTURE CDM","code_information":[{"code":"Px00098110709","type":"CDM"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1266.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24600 TREAT ELBOW DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110713","type":"CDM"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1523.0,"discounted_cash":1142.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1523.0,"discounted_cash":1142.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1830.0,"discounted_cash":1372.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1380.0,"discounted_cash":1035.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 24605 TREAT ELBOW DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110714","type":"CDM"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1896.0,"discounted_cash":1422.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1896.0,"discounted_cash":1422.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2515.0,"discounted_cash":1886.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM","code_information":[{"code":"Px00098110716","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":300.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":401.0,"discounted_cash":300.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":406.0,"discounted_cash":304.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24650 TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00098110718","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":810.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1080.0,"discounted_cash":810.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1336.0,"discounted_cash":1002.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1007.0,"discounted_cash":755.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 24655 CLOSED TX RADIUS HD FRACTURE CDM","code_information":[{"code":"Px00098110720","type":"CDM"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":2160.0,"discounted_cash":1620.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24670 TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00098110722","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.0,"discounted_cash":892.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1190.0,"discounted_cash":892.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1443.0,"discounted_cash":1082.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24675 TREAT ULNAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110724","type":"CDM"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.0,"discounted_cash":1662.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25260 REPAIR FOREARM TENDON/MUSCLE CDM","code_information":[{"code":"Px00098110726","type":"CDM"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2513.0,"discounted_cash":1884.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2513.0,"discounted_cash":1884.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3333.0,"discounted_cash":2499.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25270 REPAIR FOREARM TENDON/MUSCLE SINGLE EA TENDON CDM","code_information":[{"code":"Px00098110728","type":"CDM"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":1470.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1961.0,"discounted_cash":1470.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2601.0,"discounted_cash":1950.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25270 REPAIR FOREARM TENDON/MUSCLE SINGLE EA TENDON 54 MOD CDM","code_information":[{"code":"Px00098110729","type":"CDM"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2601.0,"discounted_cash":1950.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR 25500 TREAT FRACTUE OF RADIUS W/O MANIPULATION","code_information":[{"code":"Px00098110730","type":"CDM"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1161.0,"discounted_cash":870.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 25505 TREAT FRACTURE OF RADIUS W/MANIPULATION CDM","code_information":[{"code":"Px00098110732","type":"CDM"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2449.0,"discounted_cash":1836.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25530 TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00098110734","type":"CDM"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":812.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1083.0,"discounted_cash":812.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1321.0,"discounted_cash":990.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25535 TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00098110736","type":"CDM"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2426.0,"discounted_cash":1819.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25560 TREAT FRACTURE OF RADIUS AND ULNA W/O MANIP CDM","code_information":[{"code":"Px00098110738","type":"CDM"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1183.0,"discounted_cash":887.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1183.0,"discounted_cash":887.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1403.0,"discounted_cash":1052.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25565 TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00098110740","type":"CDM"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2081.0,"discounted_cash":1560.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2081.0,"discounted_cash":1560.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2459.0,"discounted_cash":1844.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM","code_information":[{"code":"Px00098110742","type":"CDM"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":1034.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1379.0,"discounted_cash":1034.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1754.0,"discounted_cash":1315.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1322.0,"discounted_cash":991.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF CDM","code_information":[{"code":"Px00098110744","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2162.0,"discounted_cash":1621.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2162.0,"discounted_cash":1621.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2705.0,"discounted_cash":2028.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 25622 TREAT WRIST BONE FRACTURE CDM","code_information":[{"code":"Px00098110746","type":"CDM"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":1253.0,"discounted_cash":939.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1253.0,"discounted_cash":939.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1533.0,"discounted_cash":1149.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25624 TREAT WRIST BONE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110748","type":"CDM"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":2381.0,"discounted_cash":1785.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25630 TREAT CARPAL BONE FRACTURE W/O MANIP EACH BONE CDM","code_information":[{"code":"Px00098110750","type":"CDM"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1244.0,"discounted_cash":933.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1244.0,"discounted_cash":933.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1535.0,"discounted_cash":1151.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1157.0,"discounted_cash":867.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 25635 TREAT CARPAL BONE FRACTURE W/MANIPULATOPM EACH BONE CDM","code_information":[{"code":"Px00098110752","type":"CDM"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2262.0,"discounted_cash":1696.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25650 TREAT ULNAR STYLOID FRACTURE CDM","code_information":[{"code":"Px00098110754","type":"CDM"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1335.0,"discounted_cash":1001.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1335.0,"discounted_cash":1001.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1645.0,"discounted_cash":1233.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 25675 TREAT DISTAL RADIOULNAR DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110757","type":"CDM"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":2209.0,"discounted_cash":1656.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26010 DRAINAGE OF FINGER ABSCESS - SMPL CDM","code_information":[{"code":"Px00098110761","type":"CDM"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.0,"discounted_cash":963.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1285.0,"discounted_cash":963.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":732.0,"discounted_cash":549.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26011 DRAINAGE OF FINGER ABSCESS COMP CDM","code_information":[{"code":"Px00098110762","type":"CDM"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1797.0,"discounted_cash":1347.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1797.0,"discounted_cash":1347.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":964.0,"discounted_cash":723.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":727.0,"discounted_cash":545.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 26350 REPAIR FINGER/HAND TENDON CDM","code_information":[{"code":"Px00098110763","type":"CDM"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":3836.0,"discounted_cash":2877.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26410 REPAIR EXTENSOR TENDON HAND W/OGRAFT CDM","code_information":[{"code":"Px00098110765","type":"CDM"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":1744.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2326.0,"discounted_cash":1744.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3085.0,"discounted_cash":2313.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26418 REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT CDM","code_information":[{"code":"Px00098110767","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2418.0,"discounted_cash":1813.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2418.0,"discounted_cash":1813.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3208.0,"discounted_cash":2406.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26433 REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRAFT CDM","code_information":[{"code":"Px00098110769","type":"CDM"},{"code":"26433","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1659.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2212.0,"discounted_cash":1659.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00098110770","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1554.0,"discounted_cash":1165.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00098110771","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1228.0,"discounted_cash":921.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1554.0,"discounted_cash":1165.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP CDM","code_information":[{"code":"Px00098110773","type":"CDM"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1335.0,"discounted_cash":1001.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1335.0,"discounted_cash":1001.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1598.0,"discounted_cash":1198.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26641 TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110775","type":"CDM"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":2046.0,"discounted_cash":1534.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26645 TX CARPOMETACARPAL FRACTURE/DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110777","type":"CDM"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2107.0,"discounted_cash":1580.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26670 CLTX CARPO/METACARPL DISLC NOT THMB MANJ EA W/O ANES CDM","code_information":[{"code":"Px00098110779","type":"CDM"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":1072.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1430.0,"discounted_cash":1072.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1695.0,"discounted_cash":1271.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110781","type":"CDM"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":1034.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1379.0,"discounted_cash":1034.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1684.0,"discounted_cash":1263.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26705 TREAT KNUCKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110782","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1761.0,"discounted_cash":1320.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1761.0,"discounted_cash":1320.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 26720 CLOSED TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/O MA CDM","code_information":[{"code":"Px00098110783","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1027.0,"discounted_cash":770.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26725 CLOSED TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/MANI CDM","code_information":[{"code":"Px00098110786","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":1038.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1384.0,"discounted_cash":1038.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1635.0,"discounted_cash":1226.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26740 CLOSED TX ARTICULAR FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110788","type":"CDM"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":897.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26742 CLOSED TX ARTICULAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110790","type":"CDM"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":1791.0,"discounted_cash":1343.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26750 CLOSED TX DISTAL PHALANGEAL FRACTURE FING/THMB W/O MANI CDM","code_information":[{"code":"Px00098110792","type":"CDM"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":579.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":772.0,"discounted_cash":579.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1036.0,"discounted_cash":777.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26755 CLOSED TX DISTAL PHALANGEAL FRACTURE FING/THMB W/MANIP CDM","code_information":[{"code":"Px00098110794","type":"CDM"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":979.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1306.0,"discounted_cash":979.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1482.0,"discounted_cash":1111.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/THUMB EA CDM","code_information":[{"code":"Px00098110795","type":"CDM"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.0,"discounted_cash":1499.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1999.0,"discounted_cash":1499.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2652.0,"discounted_cash":1989.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110798","type":"CDM"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1176.0,"discounted_cash":882.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1176.0,"discounted_cash":882.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1420.0,"discounted_cash":1065.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 56405 I & D OF VULVA/PERINEUM CDM","code_information":[{"code":"Px00098110802","type":"CDM"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":420.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":561.0,"discounted_cash":420.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":654.0,"discounted_cash":490.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 56420 DRAINAGE OF GLAND ABSCESS CDM","code_information":[{"code":"Px00098110803","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":531.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":708.0,"discounted_cash":531.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":564.0,"discounted_cash":423.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 57020 DRAINAGE OF PELVIC FLUID CDM","code_information":[{"code":"Px00098110804","type":"CDM"},{"code":"57020","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":356.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":475.0,"discounted_cash":356.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 57180 TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00098110806","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":564.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":753.0,"discounted_cash":564.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":620.0,"discounted_cash":465.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 57510 CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00098110807","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":476.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":635.0,"discounted_cash":476.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":577.0,"discounted_cash":432.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 58301 REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00098110808","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":315.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":420.0,"discounted_cash":315.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":336.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM","code_information":[{"code":"Px00098110812","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":420.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":561.0,"discounted_cash":420.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":328.0,"discounted_cash":246.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64400 NERVE BLOCK INJ TRIGEMINAL CDM","code_information":[{"code":"Px00098110814","type":"CDM"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":267.0,"discounted_cash":200.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64421 INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL CDM","code_information":[{"code":"Px00098110816","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":96.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":128.0,"discounted_cash":96.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":124.0,"discounted_cash":93.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64450 NERVE BLOCK OTHER PERIPHERAL CDM","code_information":[{"code":"Px00098110817","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":211.0,"discounted_cash":158.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM","code_information":[{"code":"Px00098110818","type":"CDM"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":146.0,"discounted_cash":109.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65210 REMOVE FOREIGN BODY FROM EYE EMBEDDED CDM","code_information":[{"code":"Px00098110819","type":"CDM"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":109.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":146.0,"discounted_cash":109.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":182.0,"discounted_cash":136.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65220 REMOVE FOREIGN BODY FROM EYE CORNEAL W/O SLIT LAMP CDM","code_information":[{"code":"Px00098110820","type":"CDM"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":174.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":232.0,"discounted_cash":174.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":207.0,"discounted_cash":155.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65222 REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM","code_information":[{"code":"Px00098110821","type":"CDM"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":194.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":259.0,"discounted_cash":194.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":251.0,"discounted_cash":188.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 65600 REVISION OF CORNEA CDM","code_information":[{"code":"Px00098110824","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.0,"discounted_cash":1245.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1661.0,"discounted_cash":1245.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1734.0,"discounted_cash":1300.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 67700 DRAINAGE OF EYELID ABSCESS CDM","code_information":[{"code":"Px00098110825","type":"CDM"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.0,"discounted_cash":792.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1056.0,"discounted_cash":792.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":593.0,"discounted_cash":444.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 67938 REMOVE EYELID FOREIGN BODY CDM","code_information":[{"code":"Px00098110826","type":"CDM"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":436.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69000 DRAIN EXTERNAL EAR LESION SIMPLE CDM","code_information":[{"code":"Px00098110827","type":"CDM"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":531.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":708.0,"discounted_cash":531.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":645.0,"discounted_cash":483.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69005 DRAIN EXTERNAL EAR LESION COMPLICATED CDM","code_information":[{"code":"Px00098110828","type":"CDM"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":841.0,"discounted_cash":630.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":841.0,"discounted_cash":630.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":832.0,"discounted_cash":624.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69020 DRAIN OUTER EAR CANAL LESION CDM","code_information":[{"code":"Px00098110829","type":"CDM"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":659.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":739.0,"discounted_cash":554.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69200 CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00098110830","type":"CDM"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":232.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":310.0,"discounted_cash":232.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":245.0,"discounted_cash":183.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM","code_information":[{"code":"Px00098110831","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":184.0,"discounted_cash":138.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":163.0,"discounted_cash":122.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64420 NERVE BLOCK INJ INTERCOSTA SINGLE CDM","code_information":[{"code":"Px00098110833","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":283.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":378.0,"discounted_cash":283.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":299.0,"discounted_cash":224.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 26951 AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM","code_information":[{"code":"Px00098110835","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":2738.0,"discounted_cash":2053.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2738.0,"discounted_cash":2053.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3632.0,"discounted_cash":2724.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27200 TREAT TAIL BONE FRACTURE CDM","code_information":[{"code":"Px00098110839","type":"CDM"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":573.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":765.0,"discounted_cash":573.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1031.0,"discounted_cash":773.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27220 TREAT HIP SOCKET FRACTURE CDM","code_information":[{"code":"Px00098110841","type":"CDM"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2162.0,"discounted_cash":1621.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27230 TX THIGH FRACTURE PROX END NECK W/O MANIP CDM","code_information":[{"code":"Px00098110844","type":"CDM"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2516.0,"discounted_cash":1887.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27238 CLD TX INTER/PERI/OR SUB-TROCHANTERIC THIGH FX W/O MANIP CDM","code_information":[{"code":"Px00098110845","type":"CDM"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":2464.0,"discounted_cash":1848.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27246 CLOSED TX GREATER TROCHANTERIC FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110848","type":"CDM"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1533.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1541.0,"discounted_cash":1155.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27250 CLOSED TX HIP DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110850","type":"CDM"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":517.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":690.0,"discounted_cash":517.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":915.0,"discounted_cash":686.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27252 CLOSED TX HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110851","type":"CDM"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2916.0,"discounted_cash":2187.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2916.0,"discounted_cash":2187.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3868.0,"discounted_cash":2901.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"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":2209.0,"discounted_cash":1656.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1665.0,"discounted_cash":1248.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27266 TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110855","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3034.0,"discounted_cash":2275.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 26952 AMPUTATE FINGER/THUMB SINGLE W/LOCAL ADV FLAPS CDM","code_information":[{"code":"Px00098110858","type":"CDM"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.0,"discounted_cash":1995.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2660.0,"discounted_cash":1995.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 26432 CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING CDM","code_information":[{"code":"Px00098110859","type":"CDM"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1586.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2115.0,"discounted_cash":1586.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 24201 REMOVAL OF ARM FOREIGN BODY ARM/ELBOW CDM","code_information":[{"code":"Px00098110863","type":"CDM"},{"code":"24201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":1579.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27301 DRAIN THIGH/KNEE LESION CDM","code_information":[{"code":"Px00098110864","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2611.0,"discounted_cash":1958.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2611.0,"discounted_cash":1958.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2652.0,"discounted_cash":1989.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1999.0,"discounted_cash":1499.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27372 REMOVAL OF FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00098110865","type":"CDM"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":2095.0,"discounted_cash":1571.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27500 CLOSED TREAT FEMORAL SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110866","type":"CDM"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2071.0,"discounted_cash":1553.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2071.0,"discounted_cash":1553.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2520.0,"discounted_cash":1890.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27502 CL TX OF FEMORAL SHAFT FX W/MANIP CDM","code_information":[{"code":"Px00098110869","type":"CDM"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":2932.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27508 TREAT FEMORAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110871","type":"CDM"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":2627.0,"discounted_cash":1970.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27510 CLOSED TREATMENT OF DISTAL END FEMOR FRACTURE CDM","code_information":[{"code":"Px00098110872","type":"CDM"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3540.0,"discounted_cash":2655.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27520 CLOSED TX PATELLAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110873","type":"CDM"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":990.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1321.0,"discounted_cash":990.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1618.0,"discounted_cash":1213.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION CDM","code_information":[{"code":"Px00098110876","type":"CDM"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1248.0,"discounted_cash":936.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1248.0,"discounted_cash":936.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1555.0,"discounted_cash":1166.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27550 TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00098110878","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1533.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2044.0,"discounted_cash":1533.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2486.0,"discounted_cash":1864.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27552 CLOSED TREAT KNEE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110879","type":"CDM"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2506.0,"discounted_cash":1879.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2506.0,"discounted_cash":1879.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3325.0,"discounted_cash":2493.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27560 CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110881","type":"CDM"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1503.0,"discounted_cash":1127.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1503.0,"discounted_cash":1127.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1819.0,"discounted_cash":1364.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27562 CLOSED TREAT PATELLA DISLOCATION W/ANSETH CDM","code_information":[{"code":"Px00098110882","type":"CDM"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.0,"discounted_cash":1944.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27603 DRAIN LOWER LEG LESION DEEP CDM","code_information":[{"code":"Px00098110884","type":"CDM"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2008.0,"discounted_cash":1506.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2008.0,"discounted_cash":1506.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2010.0,"discounted_cash":1507.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27650 REPAIR ACHILLES TENDON CDM","code_information":[{"code":"Px00098110886","type":"CDM"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2580.0,"discounted_cash":1935.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2580.0,"discounted_cash":1935.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3423.0,"discounted_cash":2567.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27750 CLOSED TREAT TIB SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110888","type":"CDM"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":1053.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1405.0,"discounted_cash":1053.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1729.0,"discounted_cash":1296.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27752 CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110890","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":2131.0,"discounted_cash":1598.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2131.0,"discounted_cash":1598.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2581.0,"discounted_cash":1935.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27760 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110892","type":"CDM"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":1014.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1352.0,"discounted_cash":1014.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1654.0,"discounted_cash":1240.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1247.0,"discounted_cash":935.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27762 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110895","type":"CDM"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1938.0,"discounted_cash":1453.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1938.0,"discounted_cash":1453.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2319.0,"discounted_cash":1739.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27766 OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE CDM","code_information":[{"code":"Px00098110896","type":"CDM"},{"code":"27766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2381.0,"discounted_cash":1785.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2381.0,"discounted_cash":1785.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3158.0,"discounted_cash":2368.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27768 CLTX POST ANKLE FX W/MANIPULATION CDM","code_information":[{"code":"Px00098110897","type":"CDM"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.0,"discounted_cash":1784.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 27780 CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP CDM","code_information":[{"code":"Px00098110898","type":"CDM"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1256.0,"discounted_cash":942.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1256.0,"discounted_cash":942.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1533.0,"discounted_cash":1149.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":1156.0,"discounted_cash":867.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 27781 CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM","code_information":[{"code":"Px00098110900","type":"CDM"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1757.0,"discounted_cash":1317.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1757.0,"discounted_cash":1317.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2146.0,"discounted_cash":1609.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 36593 DECLOT VASCULAR DEVICE CDM","code_information":[{"code":"Px00098110904","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":132.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 28600 TREAT FOOT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110905","type":"CDM"},{"code":"28600","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.0,"discounted_cash":657.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":877.0,"discounted_cash":657.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":992.0,"discounted_cash":744.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 29130 APLICATION OF FINGER SPLINT STATIC CDM","code_information":[{"code":"Px00098110906","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":166.0,"discounted_cash":124.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":148.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 49082 ABD PARACENT W/O IMAG GUID CDM","code_information":[{"code":"Px00098110907","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":594.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":792.0,"discounted_cash":594.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":370.0,"discounted_cash":277.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM","code_information":[{"code":"Px00098110908","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":822.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1097.0,"discounted_cash":822.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":535.0,"discounted_cash":401.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 49084 PF PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00098110909","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":410.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 81002 URINALYSIS COMPLETE CDM","code_information":[{"code":"Px00098110915","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":15.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":21.0,"discounted_cash":15.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED A4550 SURGICAL TRAYS CDM","code_information":[{"code":"Px00098110917","type":"CDM"},{"code":"A4550","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":19.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED Q2039 NOS FLU VACC, 3 YRS & >, IM CDM","code_information":[{"code":"Px00098110923","type":"CDM"},{"code":"Q2039","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":32.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32557 INSERT CATH PLEURA W/ IMAG GD CDM","code_information":[{"code":"Px00098110928","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":558.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32556 INSERT CATH PLEURA W/O IMAG GD CDM","code_information":[{"code":"Px00098110929","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":470.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":472.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM","code_information":[{"code":"Px00098110930","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":408.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 32554 THORACENTESIS/ASPIR W/O IMG GD CDM","code_information":[{"code":"Px00098110931","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":659.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":879.0,"discounted_cash":659.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":443.0,"discounted_cash":332.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 24565 ER CLOSED TX HUMERAL EPICOND FX ME/LA W/ CDM","code_information":[{"code":"Px00098110934","type":"CDM"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2629.0,"discounted_cash":1971.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 15120 ER SPLIT GFT FACE 1ST 100 SQ CM/LESS/1% CDM","code_information":[{"code":"Px00098110938","type":"CDM"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3261.0,"discounted_cash":2445.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":3261.0,"discounted_cash":2445.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 76512 OPHTH US B W/NON-QUANT A CDM","code_information":[{"code":"Px00098110952","type":"CDM"},{"code":"76512","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":182.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 69801 LABYRINTHOTOMY W PERFUS VESTIBULOACTIVE DRUGS TRNSCRAN CDM","code_information":[{"code":"Px00098110954","type":"CDM"},{"code":"69801","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":651.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":868.0,"discounted_cash":651.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR ED 76536 HEAD AND NECK SOFT TISSUES CDM","code_information":[{"code":"Px00098110955","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":417.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"}]},{"description":"HC PR ED 64415 INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN CDM","code_information":[{"code":"Px00098110982","type":"CDM"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 97598 RMVL DEVITAL TIS ADDL 20 CM LESS","code_information":[{"code":"Px00098210021","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27331 EXPLORE/TREAT KNEE JOINT","code_information":[{"code":"Px00098210074","type":"CDM"},{"code":"27331","type":"HCPCS"}],"standard_charges":[{"gross_charge":1892.0,"discounted_cash":1419.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64430 NERVE BLOCK INJ PUDENDAL","code_information":[{"code":"Px00098210111","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":281.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":375.0,"discounted_cash":281.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11444 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM CDM","code_information":[{"code":"Px00098300010","type":"CDM"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":822.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"}]},{"description":"HC PR 30300 REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE CDM","code_information":[{"code":"Px00098300015","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":595.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":794.0,"discounted_cash":595.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":468.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64420 INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL CDM","code_information":[{"code":"Px00098300033","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 69100 BIOPSY EXTERNAL EAR CDM","code_information":[{"code":"Px00098300035","type":"CDM"},{"code":"69100","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":271.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":362.0,"discounted_cash":271.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 69420 MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ CDM","code_information":[{"code":"Px00098300036","type":"CDM"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":548.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":731.0,"discounted_cash":548.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 45305 PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00098300077","type":"CDM"},{"code":"45305","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":211.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 49082 ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00098300096","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":594.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":792.0,"discounted_cash":594.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":279.0,"discounted_cash":209.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51700 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ CDM","code_information":[{"code":"Px00098300099","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":218.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":291.0,"discounted_cash":218.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE CDM","code_information":[{"code":"Px00098300100","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":420.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":561.0,"discounted_cash":420.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64642 CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE CDM","code_information":[{"code":"Px00098300114","type":"CDM"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":309.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 11057 PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 CDM","code_information":[{"code":"Px00098300142","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11740 EVACUATION SUBUNGUAL HEMATOMA CDM","code_information":[{"code":"Px00098300143","type":"CDM"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":95.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29540 STRAPPING ANKLE &/FOOT CDM","code_information":[{"code":"Px00098300147","type":"CDM"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64455 NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE CDM","code_information":[{"code":"Px00098300148","type":"CDM"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":95.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0127 TRIM DYSTROPHIC NAIL ANY NUMBER CDM","code_information":[{"code":"Px00098300149","type":"CDM"},{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57421 COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX CDM","code_information":[{"code":"Px00098300166","type":"CDM"},{"code":"57421","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":685.0,"discounted_cash":513.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 57452 COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA CDM","code_information":[{"code":"Px00098300167","type":"CDM"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":263.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 58110 ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY CDM","code_information":[{"code":"Px00098300170","type":"CDM"},{"code":"58110","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":116.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58301 REMOVAL INTRAUTERINE DEVICE IUD CDM","code_information":[{"code":"Px00098300171","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":315.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":420.0,"discounted_cash":315.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":253.0,"discounted_cash":189.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57465 COMPUTER-AIDED MAPG CERVIX UTERI DRG COLPOSCOPY RHC","code_information":[{"code":"Px00098300177","type":"CDM"},{"code":"57465","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32554 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING (32554) CDM","code_information":[{"code":"Px00098300181","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93248 EXTERNAL ECG REC/ GT 7 DAYS/ UP TO 15 DAYS R&I CDM","code_information":[{"code":"Px00098300183","type":"CDM"},{"code":"93248","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99417 PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES CDM","code_information":[{"code":"Px00098300184","type":"CDM"},{"code":"99417","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93241 EXTERNAL ECG REC GT/48HR LT/7D SCAN ALYS REPORT R&I CDM","code_information":[{"code":"Px00098300187","type":"CDM"},{"code":"93241","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":771.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G2211 COMPLEX E/M VISIT ADD ON CDM","code_information":[{"code":"Px00098300195","type":"CDM"},{"code":"G2211","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G2212 PROLONG OUTPT/OFFICE VIS CDM","code_information":[{"code":"Px00098300196","type":"CDM"},{"code":"G2212","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29584 APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING CDM","code_information":[{"code":"Px00098300199","type":"CDM"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL CDM","code_information":[{"code":"Px00098300303","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":532.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10180 INCISION & DRAINAGE COMPLEX PO WOUND INFECTION CDM","code_information":[{"code":"Px00098300304","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM CDM","code_information":[{"code":"Px00098300305","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM CDM","code_information":[{"code":"Px00098300306","type":"CDM"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":165.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM CDM","code_information":[{"code":"Px00098300308","type":"CDM"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":594.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29130 APPLICATION FINGER SPLINT STATIC CDM","code_information":[{"code":"Px00098300317","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":124.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":166.0,"discounted_cash":124.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":111.0,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23500 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098300319","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":684.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":913.0,"discounted_cash":684.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":934.0,"discounted_cash":700.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23600 CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098300323","type":"CDM"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.0,"discounted_cash":963.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23620 CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ CDM","code_information":[{"code":"Px00098300324","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1103.0,"discounted_cash":827.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1056.0,"discounted_cash":792.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23545 CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION CDM","code_information":[{"code":"Px00098300327","type":"CDM"},{"code":"23545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.0,"discounted_cash":1097.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1463.0,"discounted_cash":1097.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA CDM","code_information":[{"code":"Px00098300344","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":824.0,"discounted_cash":618.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26770 CLTX IPHAL JT DISLC W/MANJ W/O ANES CDM","code_information":[{"code":"Px00098300345","type":"CDM"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":802.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL CDM","code_information":[{"code":"Px00098300347","type":"CDM"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":109.0,"discounted_cash":81.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM CDM","code_information":[{"code":"Px00098300355","type":"CDM"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":1111.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1482.0,"discounted_cash":1111.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":932.0,"discounted_cash":699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM CDM","code_information":[{"code":"Px00098300359","type":"CDM"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":700.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM CDM","code_information":[{"code":"Px00098300360","type":"CDM"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"},{"gross_charge":736.0,"discounted_cash":552.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 29550 STRAPPING TOES CDM","code_information":[{"code":"Px00098300371","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24530 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ CDM","code_information":[{"code":"Px00098300375","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":1162.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1550.0,"discounted_cash":1162.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1418.0,"discounted_cash":1063.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24650 CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION CDM","code_information":[{"code":"Px00098300378","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":810.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1080.0,"discounted_cash":810.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1007.0,"discounted_cash":755.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ CDM","code_information":[{"code":"Px00098300380","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.0,"discounted_cash":1515.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2021.0,"discounted_cash":1515.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 24565 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ CDM","code_information":[{"code":"Px00098300382","type":"CDM"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1981.0,"discounted_cash":1485.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ CDM","code_information":[{"code":"Px00098300385","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":229.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ CDM","code_information":[{"code":"Px00098300391","type":"CDM"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":1034.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1379.0,"discounted_cash":1034.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1322.0,"discounted_cash":991.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25630 CLTX CARPAL BONE FX W/O MANJ EACH BONE CDM","code_information":[{"code":"Px00098300393","type":"CDM"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1244.0,"discounted_cash":933.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1244.0,"discounted_cash":933.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1157.0,"discounted_cash":867.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26011 DRAINAGE FINGER ABSCESS COMPLICATED CDM","code_information":[{"code":"Px00098300412","type":"CDM"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1797.0,"discounted_cash":1347.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1797.0,"discounted_cash":1347.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":727.0,"discounted_cash":545.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27750 CLTX TIBIAL SHAFT FX W/O MANIPULATION CDM","code_information":[{"code":"Px00098300414","type":"CDM"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":977.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27760 CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION CDM","code_information":[{"code":"Px00098300415","type":"CDM"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":935.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27780 CLTX PROX FIBULA/SHFT FX W/O MANJ CDM","code_information":[{"code":"Px00098300416","type":"CDM"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1256.0,"discounted_cash":942.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1256.0,"discounted_cash":942.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1156.0,"discounted_cash":867.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ CDM","code_information":[{"code":"Px00098300417","type":"CDM"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":947.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1263.0,"discounted_cash":947.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1156.0,"discounted_cash":867.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27808 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ CDM","code_information":[{"code":"Px00098300418","type":"CDM"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1361.0,"discounted_cash":1020.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1361.0,"discounted_cash":1020.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1238.0,"discounted_cash":928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27752 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ CDM","code_information":[{"code":"Px00098300422","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":2131.0,"discounted_cash":1598.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2131.0,"discounted_cash":1598.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1946.0,"discounted_cash":1459.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ CDM","code_information":[{"code":"Px00098300425","type":"CDM"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.0,"discounted_cash":1282.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION CDM","code_information":[{"code":"Px00098300426","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1759.0,"discounted_cash":1319.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28400 CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098300427","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.0,"discounted_cash":744.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":993.0,"discounted_cash":744.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 28430 CLOSED TX TALUS FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098300428","type":"CDM"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.0,"discounted_cash":722.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":963.0,"discounted_cash":722.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":847.0,"discounted_cash":635.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28450 TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ CDM","code_information":[{"code":"Px00098300429","type":"CDM"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":635.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":847.0,"discounted_cash":635.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":768.0,"discounted_cash":576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28510 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ CDM","code_information":[{"code":"Px00098300431","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":486.0,"discounted_cash":364.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":486.0,"discounted_cash":364.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28475 CLTX METATARSAL FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098300435","type":"CDM"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":685.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 99418 PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN CDM","code_information":[{"code":"Px00098300452","type":"CDM"},{"code":"99418","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 15854 REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00098300453","type":"CDM"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":55.0,"discounted_cash":41.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":55.0,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/OR LESS CDM","code_information":[{"code":"Px00098300468","type":"CDM"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":240.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17000 DESTRUCTION PREMALIGNANT LESION 1ST CDM","code_information":[{"code":"Px00098300472","type":"CDM"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17003 DESTRUCTION PREMALIGNANT LESION 2-14 EA CDM","code_information":[{"code":"Px00098300473","type":"CDM"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 17111 DESTRUCTION BENIGN LESIONS 15/> CDM","code_information":[{"code":"Px00098300475","type":"CDM"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":383.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":511.0,"discounted_cash":383.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 55250 VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS CDM","code_information":[{"code":"Px00098300477","type":"CDM"},{"code":"55250","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":671.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM","code_information":[{"code":"Px00098300478","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 15853 REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00098300480","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":33.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":44.0,"discounted_cash":33.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":44.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25075 EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ/LESS THAN 3CM CDM","code_information":[{"code":"Px00098300491","type":"CDM"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1985.0,"discounted_cash":1488.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1985.0,"discounted_cash":1488.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 36556 INSERT NON-TUNNEL CV CATH > 5 CDM","code_information":[{"code":"Px00098300495","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":239.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 23931 DRAINAGE OF ARM BURSA CDM","code_information":[{"code":"Px00098300497","type":"CDM"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":474.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 26951 AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM","code_information":[{"code":"Px00098300499","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":2738.0,"discounted_cash":2053.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27301 DRAIN THIGH/KNEE LESION CDM","code_information":[{"code":"Px00098300500","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2611.0,"discounted_cash":1958.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2611.0,"discounted_cash":1958.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1999.0,"discounted_cash":1499.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27500 CLOS TREAT FEMORAL SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098300501","type":"CDM"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"discounted_cash":1425.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32556 INSERT CATH PLEURA W/O IMAG GD CDM","code_information":[{"code":"Px00098300503","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 92960 CARDIOVERSION ELECTIVE EXTERNAL","code_information":[{"code":"Px00098300507","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CPLX SCLP ARM","code_information":[{"code":"Px00098300508","type":"CDM"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.0,"discounted_cash":1014.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1353.0,"discounted_cash":1014.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":887.0,"discounted_cash":665.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27246 CLTX GREATER TROCHANTERIC FX W/O MANJ CDM","code_information":[{"code":"Px00098300509","type":"CDM"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.0,"discounted_cash":1155.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0317 PRLGNED NURSFAC E&M BEYOND TIME OF PRIMARY SVC EA ADDL 15MIN","code_information":[{"code":"Px00098300522","type":"CDM"},{"code":"G0317","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11646 EXC MALIGNANT LESION FC/ERS/EYLD/NS/LPS GT 4.0 CM CDM","code_information":[{"code":"Px00098300539","type":"CDM"},{"code":"11646","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.0,"discounted_cash":1457.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1943.0,"discounted_cash":1457.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 12036 INTMD REPAIR SCLP/AX/TRK/EXTR 20.1-30.0 CM CDM","code_information":[{"code":"Px00098300556","type":"CDM"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.0,"discounted_cash":819.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99459 PELVIC EXAMINATION ADD-ON CDM","code_information":[{"code":"Px00098300564","type":"CDM"},{"code":"99459","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":61.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":82.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57460 COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX CDM","code_information":[{"code":"Px00098300567","type":"CDM"},{"code":"57460","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR D0191 ASSESSMENT OF A PATIENT","code_information":[{"code":"Px00098300570","type":"CDM"},{"code":"D0191","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC PR 29807 SHLDR ARTHROSCOP SURG,REPAIR SLAP LESION","code_information":[{"code":"Px00098300587","type":"CDM"},{"code":"29807","type":"HCPCS"}],"standard_charges":[{"gross_charge":4028.0,"discounted_cash":3021.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 55876 PLMT INTERSTITIAL DEV RADIAT TX PROSTATE CDM","code_information":[{"code":"Px00098300716","type":"CDM"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 40800 DRAINAGE OF MOUTH LESION, SIMPLE CDM","code_information":[{"code":"Px00098300768","type":"CDM"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":350.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99202 NEW PT VISIT - LEVEL 2","code_information":[{"code":"Px00098310002","type":"CDM"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":207.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":276.0,"discounted_cash":207.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99203 NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00098310003","type":"CDM"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":314.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99204 NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00098310004","type":"CDM"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":484.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":646.0,"discounted_cash":484.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":511.0,"discounted_cash":383.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99205 NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00098310005","type":"CDM"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.0,"discounted_cash":640.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":854.0,"discounted_cash":640.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":695.0,"discounted_cash":521.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99211 ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00098310006","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":90.0,"discounted_cash":67.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":33.0,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99212 ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00098310007","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":163.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":218.0,"discounted_cash":163.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99213 ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00098310008","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":264.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":352.0,"discounted_cash":264.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":252.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99214 ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00098310009","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":495.0,"discounted_cash":371.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":371.0,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99215 ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00098310010","type":"CDM"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":521.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":695.0,"discounted_cash":521.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":549.0,"discounted_cash":411.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99499 EXAM, FIT FOR DUTY CNTR","code_information":[{"code":"Px00098310020","type":"CDM"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":22.0,"discounted_cash":16.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR G0438 PPPS, INITIAL VISIT","code_information":[{"code":"Px00098310030","type":"CDM"},{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":476.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":635.0,"discounted_cash":476.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":635.0,"discounted_cash":476.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0439 PPPS, SUBSEQ VISIT","code_information":[{"code":"Px00098310031","type":"CDM"},{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":375.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":500.0,"discounted_cash":375.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":500.0,"discounted_cash":375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 47379 LAPAROSCOPE PROCEDURE LIVER","code_information":[{"code":"Px00098310054","type":"CDM"},{"code":"47379","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":752.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 56501 DESTROY VULVA LESIONS SIMPLE","code_information":[{"code":"Px00098310059","type":"CDM"},{"code":"56501","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":549.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":733.0,"discounted_cash":549.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":517.0,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 56606 BIOPSY OF VULVA/PERINEUM, EA ADDL LESION","code_information":[{"code":"Px00098310060","type":"CDM"},{"code":"56606","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":108.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":110.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57420 EXAM OF VAGINA W/SCOPE - COLPSCOPY","code_information":[{"code":"Px00098310065","type":"CDM"},{"code":"57420","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":384.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 57455 BIOPSY OF CERVIX W/SCOPE","code_information":[{"code":"Px00098310066","type":"CDM"},{"code":"57455","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":466.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":622.0,"discounted_cash":466.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":419.0,"discounted_cash":314.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 57456 ENDOCERVICAL CURETTAGE W/SCOPE","code_information":[{"code":"Px00098310067","type":"CDM"},{"code":"57456","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":436.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":385.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99497 ADVANCE CARE PLANNING FIRST 30 MINS","code_information":[{"code":"Px00098310084","type":"CDM"},{"code":"99497","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":215.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 92504 BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE","code_information":[{"code":"Px00098310105","type":"CDM"},{"code":"92504","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":82.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":110.0,"discounted_cash":82.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 98925 OSTEOPATHIC MANIPULATION - 1-2 BODY REGIONS","code_information":[{"code":"Px00098310134","type":"CDM"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 98926 OSTEOPATHIC MANIPULATION - 3-4 BODY REGIONS","code_information":[{"code":"Px00098310135","type":"CDM"},{"code":"98926","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 98927 OSTEOPATHIC MANIPULATION - 5-6 BODY REGIONS","code_information":[{"code":"Px00098310136","type":"CDM"},{"code":"98927","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0405 ECG 12 LEAD INTERP & REPT MCARE SCN","code_information":[{"code":"Px00098310167","type":"CDM"},{"code":"G0405","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":31.0,"discounted_cash":23.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 58605 DIVISION OF FALLOPIAN TUBE -POST PRTM","code_information":[{"code":"Px00098310169","type":"CDM"},{"code":"58605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 41010 INCISION OF TONGUE FOLD (AKA 41010)","code_information":[{"code":"Px00098310172","type":"CDM"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":610.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 99499 DOT EXAM","code_information":[{"code":"Px00098310186","type":"CDM"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":16.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":22.0,"discounted_cash":16.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00098310202","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":354.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":472.0,"discounted_cash":354.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":179.0,"discounted_cash":134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11105 PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00098310203","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11106 INCISIONAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00098310204","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":441.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":588.0,"discounted_cash":441.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL","code_information":[{"code":"Px00098310212","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20553 INJECT SINGLE/MLT TRIGGER POINT 3/> MUSCLES","code_information":[{"code":"Px00098310213","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":174.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":232.0,"discounted_cash":174.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":159.0,"discounted_cash":119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE","code_information":[{"code":"Px00098310215","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":369.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":415.0,"discounted_cash":311.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE","code_information":[{"code":"Px00098310216","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":534.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10080 DRAINAGE OF PILONIDAL CYST SIMPLE","code_information":[{"code":"Px00098310217","type":"CDM"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":707.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":943.0,"discounted_cash":707.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":408.0,"discounted_cash":306.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10120 REMOVE FOREIGN BODY SIMPLE","code_information":[{"code":"Px00098310218","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10140 DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"Px00098310219","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":345.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","code_information":[{"code":"Px00098310220","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":375.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":500.0,"discounted_cash":375.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":375.0,"discounted_cash":281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11042 DEB SUBQ TISSUE FIRST 20 SQ OR LESS","code_information":[{"code":"Px00098310221","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":371.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":495.0,"discounted_cash":371.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":233.0,"discounted_cash":174.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11044 DEBRIDEMENT BONE 1ST 20 SQ CM/OR LESS","code_information":[{"code":"Px00098310223","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":645.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11401 EXC TR-EXT B9+MARG 0.6-1 CM","code_information":[{"code":"Px00098310224","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":448.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":598.0,"discounted_cash":448.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11730 REMOVAL OF NAIL PLATE","code_information":[{"code":"Px00098310230","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":154.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS","code_information":[{"code":"Px00098310232","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR D0030 INSURER CONSULT EA 15 MIN","code_information":[{"code":"Px00098310292","type":"CDM"},{"code":"D0030","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":81.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0404 ECG 12 LEAD TRACING MCARE SCREEN","code_information":[{"code":"Px00098310302","type":"CDM"},{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11305 SHAVE SKIN LESION 0.5 CM OR LESS SCLP NK HND FT GEN","code_information":[{"code":"Px00098310345","type":"CDM"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":142.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11306 SHAVE SKIN LESION 0.6 TO 1.0 CM SCLP NK HND FT GEN","code_information":[{"code":"Px00098310347","type":"CDM"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11470 REMOVAL SWEAT GLAND LESION","code_information":[{"code":"Px00098310349","type":"CDM"},{"code":"11470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1743.0,"discounted_cash":1307.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1743.0,"discounted_cash":1307.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 11976 REMOVAL OF CONTRACEPTIVE CAP","code_information":[{"code":"Px00098310351","type":"CDM"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":415.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 17250 CHEMICAL CAUTERY TISSUE","code_information":[{"code":"Px00098310353","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":243.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":325.0,"discounted_cash":243.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":145.0,"discounted_cash":108.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12002 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP NK AX E","code_information":[{"code":"Px00098310360","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":329.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":439.0,"discounted_cash":329.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":225.0,"discounted_cash":168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS","code_information":[{"code":"Px00098310361","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":431.0,"discounted_cash":323.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":214.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM","code_information":[{"code":"Px00098310362","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":750.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1001.0,"discounted_cash":750.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":585.0,"discounted_cash":438.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59426 ANTEPARTUM CARE ONLY (7 OR MORE)","code_information":[{"code":"Px00098310401","type":"CDM"},{"code":"59426","type":"HCPCS"}],"standard_charges":[{"gross_charge":3974.0,"discounted_cash":2980.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":3060.0,"discounted_cash":2295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 81003 URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00098310411","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE","code_information":[{"code":"Px00098310432","type":"CDM"},{"code":"59400","type":"HCPCS"}],"standard_charges":[{"gross_charge":9321.0,"discounted_cash":6990.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":12365.0,"discounted_cash":9273.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS EMERGENCY PHYSICIANS"},{"gross_charge":9321.0,"discounted_cash":6990.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR","code_information":[{"code":"Px00098310434","type":"CDM"},{"code":"59510","type":"HCPCS"}],"standard_charges":[{"gross_charge":10354.0,"discounted_cash":7765.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":10354.0,"discounted_cash":7765.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59425 ANTEPARTUM CARE ONLY OB VISITS (4-6)","code_information":[{"code":"Px00098310437","type":"CDM"},{"code":"59425","type":"HCPCS"}],"standard_charges":[{"gross_charge":2171.0,"discounted_cash":1628.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1667.0,"discounted_cash":1250.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51701 INSERT BLADDER CATHETER","code_information":[{"code":"Px00098310440","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":169.0,"discounted_cash":126.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":96.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 59514 CESAREAN DELIVERY ONLY ASST","code_information":[{"code":"Px00098310448","type":"CDM"},{"code":"59514","type":"HCPCS"}],"standard_charges":[{"gross_charge":3483.0,"discounted_cash":2612.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99173 SCREENING TEST VISUAL ACUITY-BILAT","code_information":[{"code":"Px00098310449","type":"CDM"},{"code":"99173","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11107 INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00098310454","type":"CDM"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":201.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":269.0,"discounted_cash":201.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":116.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 76805 US OB AFTER 1ST TRIMEST 1/1ST FETUS","code_information":[{"code":"Px00098310456","type":"CDM"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":386.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76810 US OB AFTER 1ST TRIMESTER ADD FETUS","code_information":[{"code":"Px00098310457","type":"CDM"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":249.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76813 US OB NUCHAL MEASUREMENT 1 GEST","code_information":[{"code":"Px00098310458","type":"CDM"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":326.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76814 US OB NUCHAL MEASUREMENT ADD GEST","code_information":[{"code":"Px00098310459","type":"CDM"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":211.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 76820 US UMBILICAL ARTERY ECHO","code_information":[{"code":"Px00098310460","type":"CDM"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":126.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 85018 HEMOGLOBIN","code_information":[{"code":"Px00098310465","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 85610 PROTHROMBIN TIME","code_information":[{"code":"Px00098310466","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<","code_information":[{"code":"Px00098310497","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":754.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1006.0,"discounted_cash":754.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":563.0,"discounted_cash":422.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM","code_information":[{"code":"Px00098310498","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":888.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1185.0,"discounted_cash":888.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 26113 EXC HAND TUM DEEP > 1.5 CM","code_information":[{"code":"Px00098310504","type":"CDM"},{"code":"26113","type":"HCPCS"}],"standard_charges":[{"gross_charge":2164.0,"discounted_cash":1623.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0447 BEHAVIOR COUNSEL OBESITY 15M","code_information":[{"code":"Px00098310524","type":"CDM"},{"code":"G0447","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51702 INSJ TEMP INDWELLING BLADDER CATHETER SIMPLE CDM","code_information":[{"code":"Px00098310570","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93279 PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP","code_information":[{"code":"Px00098310578","type":"CDM"},{"code":"93279","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":191.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93280 PM DEVICE PROGR EVAL DUAL","code_information":[{"code":"Px00098310579","type":"CDM"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":222.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":297.0,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93288 INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON","code_information":[{"code":"Px00098310581","type":"CDM"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":212.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":212.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93291 INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON","code_information":[{"code":"Px00098310582","type":"CDM"},{"code":"93291","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99384 SPORT PHYSICAL NEW AGE 12-17","code_information":[{"code":"Px00098310741","type":"CDM"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99393 SPORT PHYSICAL EST AGE 5-11","code_information":[{"code":"Px00098310742","type":"CDM"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99394 SPORT PHYSICAL EST AGE 12-17","code_information":[{"code":"Px00098310743","type":"CDM"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR CE001 LEVEL 4 CLOSING","code_information":[{"code":"Px00098310814","type":"CDM"},{"code":"CE001","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":217.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93289 INTERROG DEVICE EVAL HEART","code_information":[{"code":"Px00098310825","type":"CDM"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":203.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":271.0,"discounted_cash":203.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":271.0,"discounted_cash":203.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93296 REM INTERROG PM/LDLS PM/IDS LTE 90 DAYS TECH REVIEW","code_information":[{"code":"Px00098310827","type":"CDM"},{"code":"93296","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93005 OM FAA CLASS 1 EKG","code_information":[{"code":"Px00098310837","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29581 MULTILAYER WND COMPRESSION","code_information":[{"code":"Px00098310855","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":75.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0248 DEMONSTRATE USE HOME INR MON","code_information":[{"code":"Px00098310895","type":"CDM"},{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":287.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR G0444 DEPRESSION SCREEN ANNUAL CDM","code_information":[{"code":"Px00098310969","type":"CDM"},{"code":"G0444","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99499 UNLISTED E/M SERVICE","code_information":[{"code":"Px00098310992","type":"CDM"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 30901 CONTROL OF NOSEBLEED SIMPLE","code_information":[{"code":"Px00098311005","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46040 INCISION OF RECTAL ABSCESS","code_information":[{"code":"Px00098311012","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2159.0,"discounted_cash":1619.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2159.0,"discounted_cash":1619.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1672.0,"discounted_cash":1254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46050 INCISION OF ANAL ABSCESS","code_information":[{"code":"Px00098311013","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46083 INCISE EXTERNAL HEMORRHOID","code_information":[{"code":"Px00098311014","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":322.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46221 LIGATION OF HEMORRHOID(S)","code_information":[{"code":"Px00098311015","type":"CDM"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":565.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 46600 DIAGNOSTIC ANOSCOPY","code_information":[{"code":"Px00098311016","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27788 CLOSED TREATMENT OF ANKLE FRACTURE W/MANIP","code_information":[{"code":"Px00098311017","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.0,"discounted_cash":1155.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29065 LONG ARM CAST APPLICATION","code_information":[{"code":"Px00098311020","type":"CDM"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29075 APPLICATION CAST ELBOW FINGER SHORT ARM","code_information":[{"code":"Px00098311021","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":185.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29105 LONG ARM SPLINT APPLICATION","code_information":[{"code":"Px00098311022","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29125 SHORT ARM SPLINT APPLICATION","code_information":[{"code":"Px00098311023","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":199.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":266.0,"discounted_cash":199.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29405 SHORT LEG CAST APPLICATION","code_information":[{"code":"Px00098311024","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":240.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":320.0,"discounted_cash":240.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":229.0,"discounted_cash":171.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29515 SHORT LEG SPLINT APPLICATION","code_information":[{"code":"Px00098311025","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":146.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 29345 APPLICATION/LONG LEG CAST","code_information":[{"code":"Px00098311026","type":"CDM"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":290.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20525 REMOVAL OF FOREIGN BODY COMPLEX","code_information":[{"code":"Px00098311028","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1789.0,"discounted_cash":1341.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1789.0,"discounted_cash":1341.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 20550 INJ TENDON SHEATH/LIGAMENT","code_information":[{"code":"Px00098311029","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20551 INJECTION SINGLE TENDON ORIGIN/INSERTION","code_information":[{"code":"Px00098311030","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDAN","code_information":[{"code":"Px00098311031","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":102.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDA","code_information":[{"code":"Px00098311032","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":105.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 37609 TEMPORAL ARTERY PROCEDURE","code_information":[{"code":"Px00098311035","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":585.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24600 TREAT ELBOW DISLOCATION W/O ANESTH","code_information":[{"code":"Px00098311036","type":"CDM"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1523.0,"discounted_cash":1142.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1523.0,"discounted_cash":1142.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1380.0,"discounted_cash":1035.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","code_information":[{"code":"Px00098311039","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1529.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26418 REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT","code_information":[{"code":"Px00098311040","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2418.0,"discounted_cash":1813.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS RHC"}]},{"description":"HC PR 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP","code_information":[{"code":"Px00098311041","type":"CDM"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26725 CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER OR THUMB W/MANI","code_information":[{"code":"Px00098311042","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":1038.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":1384.0,"discounted_cash":1038.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":1233.0,"discounted_cash":924.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 56405 I & D OF VULVA/PERINEUM","code_information":[{"code":"Px00098311044","type":"CDM"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":420.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":493.0,"discounted_cash":369.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 69200 CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA","code_information":[{"code":"Px00098311046","type":"CDM"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM","code_information":[{"code":"Px00098311047","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":92.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96156 HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT CDM","code_information":[{"code":"Px00098311058","type":"CDM"},{"code":"96156","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":257.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96158 HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN CDM","code_information":[{"code":"Px00098311059","type":"CDM"},{"code":"96158","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 96159 HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN CDM","code_information":[{"code":"Px00098311060","type":"CDM"},{"code":"96159","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":60.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93297 REM INTERROG ICPMS LT 30 D PHYS OR QHP CDM","code_information":[{"code":"Px00098311061","type":"CDM"},{"code":"93297","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":172.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":230.0,"discounted_cash":172.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":230.0,"discounted_cash":172.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93298 REM INTERROG SCRMS LT 30 D PHYS OR QHP CDM","code_information":[{"code":"Px00098311062","type":"CDM"},{"code":"93298","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":290.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":387.0,"discounted_cash":290.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":387.0,"discounted_cash":290.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99421 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/5-10 MINS CDM","code_information":[{"code":"Px00098311066","type":"CDM"},{"code":"99421","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99422 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/11-20 MINS CDM","code_information":[{"code":"Px00098311067","type":"CDM"},{"code":"99422","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99423 ONLINE DIGITAL E/M SVC EST PT/UP TO 7 DAYS/21 OR MORE MINS CDM","code_information":[{"code":"Px00098311068","type":"CDM"},{"code":"99423","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11047 DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM  CDM","code_information":[{"code":"Px00098311095","type":"CDM"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":277.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1  CDM","code_information":[{"code":"Px00098311096","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11056 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4  CDM","code_information":[{"code":"Px00098311097","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99177 OCULAR INSTRUMNT SCREEN BIL","code_information":[{"code":"Px00098311139","type":"CDM"},{"code":"99177","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 92283 COLOR VISION EXAMINATION","code_information":[{"code":"Px00098311184","type":"CDM"},{"code":"92283","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":156.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28232 INCISION OF TOE TENDON","code_information":[{"code":"Px00098311263","type":"CDM"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":706.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99465 NB RESUSCITATION","code_information":[{"code":"Px00098311274","type":"CDM"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR D1206 TOPICAL FLUORIDE VARNISH","code_information":[{"code":"Px00098311310","type":"CDM"},{"code":"D1206","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":44.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Base Price)"}]},{"description":"HC PR 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL  CDM","code_information":[{"code":"Px00098311350","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":247.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":330.0,"discounted_cash":247.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":216.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28010 TENOTOMY PERCUTANEOUS TOE SINGLE TENDON  CDM","code_information":[{"code":"Px00098311367","type":"CDM"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":685.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":914.0,"discounted_cash":685.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 29580 STRAPPING UNNA BOOT  CDM","code_information":[{"code":"Px00098311368","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS CDM","code_information":[{"code":"Px00098311377","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20606 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US CDM","code_information":[{"code":"Px00098311379","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM","code_information":[{"code":"Px00098311380","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":130.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH CDM","code_information":[{"code":"Px00098311386","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":284.0,"discounted_cash":213.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":159.0,"discounted_cash":119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99188 APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP CDM","code_information":[{"code":"Px00098311472","type":"CDM"},{"code":"99188","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":27.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99441 WA L&I ATTORNEY/INSUR CALL 5-10 MINS CDM","code_information":[{"code":"Px00098322000","type":"CDM"},{"code":"99441","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":100.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99442 WA L&I ATTORNEY/INSUR CALL 11-20 MINS CDM","code_information":[{"code":"Px00098322001","type":"CDM"},{"code":"99442","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":188.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99443 WA L&I ATTORNEY/INSUR CALL 21-30 MINS CDM","code_information":[{"code":"Px00098322002","type":"CDM"},{"code":"99443","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11401 EXC TR-EXT B9+MARG 0.6-1 CM CDM","code_information":[{"code":"Px00098330300","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 32551 INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00098330301","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":442.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 11750 REMOVAL OF NAIL B CDM","code_information":[{"code":"Px00098330306","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":294.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00098330307","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 20525 REMOVAL OF FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00098330309","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":726.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 24505 TREAT HUMERUS FX W/MANIP CDM","code_information":[{"code":"Px00098330310","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1807.0,"discounted_cash":1355.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 26720 CLOS TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/O MA CDM","code_information":[{"code":"Px00098330311","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":580.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 27266 TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098330312","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":2287.0,"discounted_cash":1715.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 28400 TREATMENT OF HEEL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098330313","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.0,"discounted_cash":692.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 36569 INSERTION PICC W/O IMG GDN 5 YR/> CDM","code_information":[{"code":"Px00098330314","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":270.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":360.0,"discounted_cash":270.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":360.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 51702 INSERT TEMP BLADDER CATHETER CDM","code_information":[{"code":"Px00098330315","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93244 EXTERNAL ECG REC/ GT 48HRS/ UP TO 7 DAYS REVIEW & INTERPRET CDM","code_information":[{"code":"Px00098500001","type":"CDM"},{"code":"93244","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93010 ECG 12 LEAD INTERP & REPT ONLY","code_information":[{"code":"Px00098510001","type":"CDM"},{"code":"93010","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93018 CARDIO STRESS TEST INTERP & REPT","code_information":[{"code":"Px00098510003","type":"CDM"},{"code":"93018","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93306 ECHO TTE 2D W/COLOR & DOP","code_information":[{"code":"Px00098510008","type":"CDM"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":558.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93227 HOLTER MONITOR PHYS REVIEW & INTERP","code_information":[{"code":"Px00098510016","type":"CDM"},{"code":"93227","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93272 CARDIAC EVENT PHYS REVIEW & INTERP","code_information":[{"code":"Px00098510017","type":"CDM"},{"code":"93272","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93308 ECHO TTE 2D M-MODE LTD","code_information":[{"code":"Px00098510019","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":280.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93312 ECHO TEE PROBE IMAGE & REPT","code_information":[{"code":"Px00098510020","type":"CDM"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.0,"discounted_cash":669.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":892.0,"discounted_cash":669.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":892.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93321 ECHO DOPPLER PULSE CONTIN LTD","code_information":[{"code":"Px00098510022","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":71.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93350 ECHO STRESS TEST W/INTERP & REPT","code_information":[{"code":"Px00098510023","type":"CDM"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 93351 ECHO STRESS W/INTERP REPT & MONITOR","code_information":[{"code":"Px00098510024","type":"CDM"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":660.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 95819 EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00098610010","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1732.0,"discounted_cash":1299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN CDM","code_information":[{"code":"Px00098700002","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":610.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL CDM","code_information":[{"code":"Px00098700004","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":308.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99221 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES CDM","code_information":[{"code":"Px00098710005","type":"CDM"},{"code":"99221","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":236.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":315.0,"discounted_cash":236.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":315.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99222 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES CDM","code_information":[{"code":"Px00098710006","type":"CDM"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":372.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":497.0,"discounted_cash":372.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":497.0,"discounted_cash":372.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES CDM","code_information":[{"code":"Px00098710007","type":"CDM"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":496.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":662.0,"discounted_cash":496.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":662.0,"discounted_cash":496.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99231 SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES CDM","code_information":[{"code":"Px00098710011","type":"CDM"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":140.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":187.0,"discounted_cash":140.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":187.0,"discounted_cash":140.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99232 SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES CDM","code_information":[{"code":"Px00098710012","type":"CDM"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":226.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":302.0,"discounted_cash":226.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":302.0,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99233 SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES CDM","code_information":[{"code":"Px00098710013","type":"CDM"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":338.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":451.0,"discounted_cash":338.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":451.0,"discounted_cash":338.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99238 HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MINS/OR LESS CDM","code_information":[{"code":"Px00098710017","type":"CDM"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":232.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":310.0,"discounted_cash":232.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":310.0,"discounted_cash":232.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99239 HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN CDM","code_information":[{"code":"Px00098710018","type":"CDM"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":328.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":438.0,"discounted_cash":328.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":438.0,"discounted_cash":328.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99234 HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN CDM","code_information":[{"code":"Px00098710024","type":"CDM"},{"code":"99234","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":278.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":371.0,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99235 HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN CDM","code_information":[{"code":"Px00098710025","type":"CDM"},{"code":"99235","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":453.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":604.0,"discounted_cash":453.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"},{"gross_charge":604.0,"discounted_cash":453.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99236 HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN CDM","code_information":[{"code":"Px00098710026","type":"CDM"},{"code":"99236","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":592.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":790.0,"discounted_cash":592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99469 SUBSEQUENT I/P PER DAY NEONATE CRITICAL CARE/28 DAYS OR YOUNGER","code_information":[{"code":"Px00098710114","type":"CDM"},{"code":"99469","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.0,"discounted_cash":1095.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM","code_information":[{"code":"Px00098810004","type":"CDM"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":462.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC MEDI"},{"gross_charge":616.0,"discounted_cash":462.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OR CAH PBB CLINIC NON-MEDI"}]},{"description":"HC PR 99245 OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES CDM","code_information":[{"code":"Px00098810005","type":"CDM"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION (Unit Price)"}]},{"description":"PENICILLIN G POTASSIUM 2.5 MILLION UNITS IN SODIUM CHLORIDE 0.9% 50 ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000100","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000000100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VODKA LIQUID","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000119","type":"CDM"},{"code":"00000000119","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000194","type":"CDM"},{"code":"00000000194","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE 100 MG/ML IV SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000312","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000000312","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE 100 MG/ML IV SYRINGE","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000313","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000000313","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000000425","type":"CDM"},{"code":"00000000425","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000432","type":"CDM"},{"code":"00000000432","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000442","type":"CDM"},{"code":"00000000442","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETIC ACID SOLN 5%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000451","type":"CDM"},{"code":"00000000451","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000465","type":"CDM"},{"code":"00000000465","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE LIQUID 0.4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000530","type":"CDM"},{"code":"00000000530","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":24.31,"discounted_cash":18.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL 0.2 MG/100ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL-BUPIVACAINE 2 MCG-0.125 %,FENTANYL 0.5 MG/250ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.1 MG/50ML-BUPIV 0.125%-NACL 0.9% EPIDURAL SYR,FENTANYL CITRATE 2 MCG/ML-BUPIVACAINE 0.125% EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001042","type":"CDM"},{"code":"00000001042","type":"NDC"}],"standard_charges":[{"gross_charge":249.22,"discounted_cash":186.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001175","type":"CDM"},{"code":"00000001175","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.99,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM 400 MG (ED PREPACK-FS) PO TABS","drug_information":{"unit":14.0,"type":"EA"},"code_information":[{"code":"Rx00000001178","type":"CDM"},{"code":"00000001178","type":"NDC"}],"standard_charges":[{"gross_charge":1361.68,"discounted_cash":1021.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00000001401","type":"CDM"},{"code":"00000001401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":72110.18,"discounted_cash":54082.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME 100 MG/ML IV SYRINGE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001517","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"00000001517","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME 100 MG/ML IV SYRINGE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001518","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"00000001518","type":"NDC"}],"standard_charges":[{"gross_charge":180.13,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000001539","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000001539","type":"NDC"}],"standard_charges":[{"gross_charge":126.43,"discounted_cash":94.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000001566","type":"CDM"},{"code":"00000001566","type":"NDC"}],"standard_charges":[{"gross_charge":107.53,"discounted_cash":80.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT (ED PREPACK-OR) INHAL AERS","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx00000001717","type":"CDM"},{"code":"00000001717","type":"NDC"}],"standard_charges":[{"gross_charge":70.87,"discounted_cash":53.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001744","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00000001744","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001745","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00000001745","type":"NDC"}],"standard_charges":[{"gross_charge":120.83,"discounted_cash":90.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"1:1 BUPIVACAINE 0.5%-EPI 1:200000 LIDOCAINE 1%-EPI 1:100000","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001783","type":"CDM"},{"code":"00000001783","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000002036","type":"CDM"},{"code":"00000002036","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":282.98,"discounted_cash":212.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002477","type":"CDM"},{"code":"00000002477","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE 4 MG/0.1ML NASAL LIQUID (PREPACK - OR)","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx00000002689","type":"CDM"},{"code":"00000002689","type":"NDC"}],"standard_charges":[{"gross_charge":261.56,"discounted_cash":196.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000002704","type":"CDM"},{"code":"00000002704","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":474.75,"discounted_cash":356.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN 200 MG/5ML (ED PREPACK-OR) PO SUSR","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000003044","type":"CDM"},{"code":"00000003044","type":"NDC"}],"standard_charges":[{"gross_charge":107.86,"discounted_cash":80.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN 400 MG/5ML (ED PREPACK-OR) PO SUSR","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003060","type":"CDM"},{"code":"00000003060","type":"NDC"}],"standard_charges":[{"gross_charge":89.81,"discounted_cash":67.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML (ED PREPACK-OR) PO SUSR","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx00000003065","type":"CDM"},{"code":"00000003065","type":"NDC"}],"standard_charges":[{"gross_charge":157.4,"discounted_cash":118.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN 5 MG/GM (ED PREPACK-OR) OP OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00000003088","type":"CDM"},{"code":"00000003088","type":"NDC"}],"standard_charges":[{"gross_charge":52.11,"discounted_cash":39.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 (ED PREPACK-OR) OTIC SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003113","type":"CDM"},{"code":"00000003113","type":"NDC"}],"standard_charges":[{"gross_charge":100.33,"discounted_cash":75.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"REMIFENTANIL 1 MG IN 100 ML NS INFUSION ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003242","type":"CDM"},{"code":"00000003242","type":"NDC"}],"standard_charges":[{"gross_charge":267.14,"discounted_cash":200.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"REMIFENTANIL 1 MG IN 50 ML NS INFUSION ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003243","type":"CDM"},{"code":"00000003243","type":"NDC"}],"standard_charges":[{"gross_charge":266.78,"discounted_cash":200.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"REMIFENTANIL 1 MG IN 20 ML NS INFUSION ONE STEP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000003244","type":"CDM"},{"code":"00000003244","type":"NDC"}],"standard_charges":[{"gross_charge":263.04,"discounted_cash":197.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INTRA ARTICULAR JOINT COCKTAIL ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003369","type":"CDM"},{"code":"00000003369","type":"NDC"}],"standard_charges":[{"gross_charge":282.93,"discounted_cash":212.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003410","type":"CDM"},{"code":"00000003410","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.4,"discounted_cash":1.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN 250 MG/5ML (ED PREPACK-OR) PO SUSR","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000003545","type":"CDM"},{"code":"00000003545","type":"NDC"}],"standard_charges":[{"gross_charge":41.37,"discounted_cash":31.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003546","type":"CDM"},{"code":"00000003546","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | NDC EA = 4 CAPSULE"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLN (CHILLED NS)","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000003583","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00000003583","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000003645","type":"CDM"},{"code":"00000003645","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG (ED PREPACK-OR) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003692","type":"CDM"},{"code":"00000003692","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | NDC EA = 4 TABLET"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003718","type":"CDM"},{"code":"00000003718","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON 4 MG (ED PREPACK-OR) PO TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003722","type":"CDM"},{"code":"00000003722","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | NDC EA = 4 TABLET"}]},{"description":"BUPIVACAINE 0.75% 10 ML WITH LIDOCAINE-EPI 2% -1:100,000 20ML ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000003783","type":"CDM"},{"code":"00000003783","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003785","type":"CDM"},{"code":"00000003785","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.69,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEPOMEDROL 40 MG WITH BUPIVACAINE 0.5% 30ML ONE STEP","drug_information":{"unit":31.0,"type":"ML"},"code_information":[{"code":"Rx00000003804","type":"CDM"},{"code":"00000003804","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003818","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00000003818","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003827","type":"CDM"},{"code":"00000003827","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHERRY SYRUP","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000003829","type":"CDM"},{"code":"00000003829","type":"NDC"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00000003849","type":"CDM"},{"code":"00000003849","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE (NAROPIN) 0.5% 20 ML WITH MORPHINE 10 MG IN NS 100 ML","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00000003867","type":"CDM"},{"code":"00000003867","type":"NDC"}],"standard_charges":[{"gross_charge":524.31,"discounted_cash":393.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM 0.5 MG (ED PREPACK-OR) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003872","type":"CDM"},{"code":"00000003872","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | NDC EA = 4 TABLET"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004000","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":962.16,"discounted_cash":721.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":219.9,"discounted_cash":164.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":108.48,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":218.43,"discounted_cash":163.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":108.48,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG (ED PREPACK-OR) PO TABS","drug_information":{"unit":30.0,"type":"EA"},"code_information":[{"code":"Rx00000004022","type":"CDM"},{"code":"00000004022","type":"NDC"}],"standard_charges":[{"gross_charge":101.32,"discounted_cash":75.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":113.19,"discounted_cash":84.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004399","type":"CDM"},{"code":"00000004399","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000004399","type":"CDM"},{"code":"00000004399","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE SOLN 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004404","type":"CDM"},{"code":"00000004404","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRYPAN BLUE INTRAOCULAR SOLN PREF SYR 0.06%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004508","type":"CDM"},{"code":"00000004508","type":"NDC"}],"standard_charges":[{"gross_charge":440.73,"discounted_cash":330.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MITOMYCIN INTRAOCULAR SOLN PREF SYRINGE 0.04% (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004744","type":"CDM"},{"code":"00000004744","type":"NDC"}],"standard_charges":[{"gross_charge":44.97,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALUMINUM CHLORIDE 35 % EX SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004745","type":"CDM"},{"code":"00000004745","type":"NDC"}],"standard_charges":[{"gross_charge":53.83,"discounted_cash":40.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPI-SHUGARCAINE BSS 0.6 ML + LIDOCAINE 4% (PF) 0.2 ML + EPINEPHRINE (1:1000) 0.2 ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004749","type":"CDM"},{"code":"00000004749","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIMETHYL SULFOXIDE COCKTAIL INTRAVESICAL SOLN","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00000004750","type":"CDM"},{"code":"J1212","type":"HCPCS"},{"code":"00000004750","type":"NDC"}],"standard_charges":[{"gross_charge":493.6,"discounted_cash":370.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004817","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00000004817","type":"NDC"}],"standard_charges":[{"gross_charge":34.71,"discounted_cash":26.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004826","type":"CDM"},{"code":"0000004826","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VASOPRESSIN 10 UNITS IN NORMAL SALINE 200 ML SIMPLE","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000004844","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00000004844","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004904","type":"CDM"},{"code":"00000004904","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID 2 GRAM IN NORMAL SALINE 100 ML - ONE STEP","drug_information":{"unit":2.0,"type":"GM"},"code_information":[{"code":"Rx00000005157","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000005157","type":"NDC"}],"standard_charges":[{"gross_charge":579.55,"discounted_cash":434.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005408","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000005408","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00000006335","type":"CDM"},{"code":"00000006335","type":"NDC"}],"standard_charges":[{"gross_charge":64.41,"discounted_cash":48.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN GLARGINE-YFGN INJ 100 UNIT/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00000006723","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000006723","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006856","type":"CDM"},{"code":"00000006856","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006857","type":"CDM"},{"code":"00000006857","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006858","type":"CDM"},{"code":"00000006858","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"Rx00000006860","type":"CDM"},{"code":"00000006860","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":64.0,"type":"ML"},"code_information":[{"code":"Rx00000006861","type":"CDM"},{"code":"00000006861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":32.0,"type":"ML"},"code_information":[{"code":"Rx00000006862","type":"CDM"},{"code":"00000006862","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":31.25,"type":"ML"},"code_information":[{"code":"Rx00000006863","type":"CDM"},{"code":"00000006863","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM 400 MG (ED PREPACK-FS) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006904","type":"CDM"},{"code":"00000006904","type":"NDC"}],"standard_charges":[{"gross_charge":8587.32,"discounted_cash":6440.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | NDC EA = 60 TABLET"}]},{"description":"ASPIRIN 1 MG/ML COMPOUNDED ORAL SUSPENSION (DESENSITIZATION PROTOCOL)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00000006949","type":"CDM"},{"code":"00000006949","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG (ED PREPACK-FS) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000008239","type":"CDM"},{"code":"00000008239","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | NDC EA = 3 TABLET"}]},{"description":"ONDANSETRON 4 MG (ED PREPACK-OR) PO TBDP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000030046","type":"CDM"},{"code":"00000030046","type":"NDC"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":52.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | NDC EA = 4 TABLET"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002021301","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002021301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":374.67,"discounted_cash":281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","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":140.82,"discounted_cash":105.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","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":140.82,"discounted_cash":105.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":202.05,"discounted_cash":151.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":337.76,"discounted_cash":253.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":26505.26,"discounted_cash":19878.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5301.08,"discounted_cash":3975.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10677.02,"discounted_cash":8007.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RAMUCIRUMAB IV SOLN 500 MG/50ML (FOR INFUSION)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00002767801","type":"CDM"},{"code":"J9308","type":"HCPCS"},{"code":"00002767801","type":"NDC"}],"standard_charges":[{"gross_charge":53384.76,"discounted_cash":40038.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":249.48,"discounted_cash":187.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002821517","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002821517","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":249.48,"discounted_cash":187.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":515.04,"discounted_cash":386.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 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":5723.55,"discounted_cash":4292.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":249.48,"discounted_cash":187.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002871517","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002871517","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"APIXABAN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089421","type":"CDM"},{"code":"00003089421","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6207.1,"discounted_cash":4655.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":64417.71,"discounted_cash":48313.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":257670.27,"discounted_cash":193252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":199.77,"discounted_cash":149.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":399.72,"discounted_cash":299.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATAZANAVIR SULFATE CAP 150 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003362412","type":"CDM"},{"code":"00003362412","type":"NDC"}],"standard_charges":[{"gross_charge":101.33,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":56509.08,"discounted_cash":42381.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":28254.45,"discounted_cash":21190.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NIVOLUMAB IV SOLN 40 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00003377211","type":"CDM"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"gross_charge":9418.2,"discounted_cash":7063.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":23545.3,"discounted_cash":17658.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20ML","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00003712511","type":"CDM"},{"code":"J9298","type":"HCPCS"},{"code":"00003712511","type":"NDC"}],"standard_charges":[{"gross_charge":219431.49,"discounted_cash":164573.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":62.62,"discounted_cash":46.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":57.43,"discounted_cash":43.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005197101","type":"CDM"},{"code":"90670","type":"HCPCS"},{"code":"00005197101","type":"NDC"}],"standard_charges":[{"gross_charge":919.44,"discounted_cash":689.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005197102","type":"CDM"},{"code":"90670","type":"HCPCS"},{"code":"00005197102","type":"NDC"}],"standard_charges":[{"gross_charge":1506.76,"discounted_cash":1130.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005200001","type":"CDM"},{"code":"90677","type":"HCPCS"},{"code":"00005200001","type":"NDC"}],"standard_charges":[{"gross_charge":1347.78,"discounted_cash":1010.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1347.78,"discounted_cash":1010.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 25 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022131","type":"CDM"},{"code":"00006022131","type":"NDC"}],"standard_charges":[{"gross_charge":45.35,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":143.17,"discounted_cash":107.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006095231","type":"CDM"},{"code":"00006095231","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":42797.04,"discounted_cash":32097.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006351659","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"00006351659","type":"NDC"}],"standard_charges":[{"gross_charge":223.49,"discounted_cash":167.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":752.44,"discounted_cash":564.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006409301","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"00006409301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006409302","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"00006409302","type":"NDC"}],"standard_charges":[{"gross_charge":154.98,"discounted_cash":116.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00006409401","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"00006409401","type":"NDC"}],"standard_charges":[{"gross_charge":452.39,"discounted_cash":339.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00006409402","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"00006409402","type":"NDC"}],"standard_charges":[{"gross_charge":467.9,"discounted_cash":350.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2786.97,"discounted_cash":2090.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":689.84,"discounted_cash":517.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":689.84,"discounted_cash":517.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PNEUMOCOCCAL VACCINE POLYVALENT SOLN PREF SYR 25 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006483701","type":"CDM"},{"code":"90732","type":"HCPCS"},{"code":"00006483701","type":"NDC"}],"standard_charges":[{"gross_charge":864.36,"discounted_cash":648.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PNEUMOCOCCAL VACCINE POLYVALENT SOLN PREF SYR 25 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006483703","type":"CDM"},{"code":"90732","type":"HCPCS"},{"code":"00006483703","type":"NDC"}],"standard_charges":[{"gross_charge":778.22,"discounted_cash":583.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00006499501","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"00006499501","type":"NDC"}],"standard_charges":[{"gross_charge":512.3,"discounted_cash":384.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00006499541","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"00006499541","type":"NDC"}],"standard_charges":[{"gross_charge":445.92,"discounted_cash":334.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":563.86,"discounted_cash":422.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":790.12,"discounted_cash":592.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":160.08,"discounted_cash":120.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":158.71,"discounted_cash":119.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003928","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003928","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003930","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003930","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004722","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004722","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004725","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004725","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009008601","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00009008601","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GELATIN ABSORBABLE SPONGE 12-7 MM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009031508","type":"CDM"},{"code":"00009031508","type":"NDC"}],"standard_charges":[{"gross_charge":40.68,"discounted_cash":30.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GELATIN ABSORBABLE SPONGE SIZE 100","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009034201","type":"CDM"},{"code":"00009034201","type":"NDC"}],"standard_charges":[{"gross_charge":194.04,"discounted_cash":145.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009034702","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00009034702","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":295.25,"discounted_cash":221.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":127.02,"discounted_cash":95.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":935.86,"discounted_cash":701.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":446.85,"discounted_cash":335.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009090218","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009090218","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009305101","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009305101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009305102","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009305102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPIRUBICIN HCL IV SOLN 50 MG/25ML (2 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00009509101","type":"CDM"},{"code":"J9178","type":"HCPCS"},{"code":"00009509101","type":"NDC"}],"standard_charges":[{"gross_charge":331.34,"discounted_cash":248.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009752903","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00009752903","type":"NDC"}],"standard_charges":[{"gross_charge":143.81,"discounted_cash":107.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9.46,"discounted_cash":7.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2821.41,"discounted_cash":2116.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BIMATOPROST OPHTH SOLN 0.01%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00023320503","type":"CDM"},{"code":"00023320503","type":"NDC"}],"standard_charges":[{"gross_charge":1087.94,"discounted_cash":815.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00023361525","type":"CDM"},{"code":"00023361525","type":"NDC"}],"standard_charges":[{"gross_charge":697.48,"discounted_cash":523.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONABOTULINUMTOXINA FOR INJ 200 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023392102","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00023392102","type":"NDC"}],"standard_charges":[{"gross_charge":5249.74,"discounted_cash":3937.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":44.34,"discounted_cash":33.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.15%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00023917705","type":"CDM"},{"code":"00023917705","type":"NDC"}],"standard_charges":[{"gross_charge":854.75,"discounted_cash":641.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00023932105","type":"CDM"},{"code":"00023932105","type":"NDC"}],"standard_charges":[{"gross_charge":801.37,"discounted_cash":601.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00024279201","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00024279201","type":"NDC"}],"standard_charges":[{"gross_charge":213.7,"discounted_cash":160.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":213.7,"discounted_cash":160.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DRONEDARONE HCL TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024414260","type":"CDM"},{"code":"00024414260","type":"NDC"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":40.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7875.43,"discounted_cash":5906.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RASBURICASE FOR IV SOLN 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024515011","type":"CDM"},{"code":"J2783","type":"HCPCS"},{"code":"00024515011","type":"NDC"}],"standard_charges":[{"gross_charge":7875.43,"discounted_cash":5906.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RASBURICASE FOR IV SOLN 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024515175","type":"CDM"},{"code":"J2783","type":"HCPCS"},{"code":"00024515175","type":"NDC"}],"standard_charges":[{"gross_charge":39377.12,"discounted_cash":29532.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":103683.86,"discounted_cash":77762.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":126.22,"discounted_cash":94.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025152034","type":"CDM"},{"code":"00025152034","type":"NDC"}],"standard_charges":[{"gross_charge":37.01,"discounted_cash":27.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025152534","type":"CDM"},{"code":"00025152534","type":"NDC"}],"standard_charges":[{"gross_charge":67.69,"discounted_cash":50.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 12000-38000-60000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032004770","type":"CDM"},{"code":"00032004770","type":"NDC"}],"standard_charges":[{"gross_charge":17.69,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":17.12,"discounted_cash":12.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":83.58,"discounted_cash":62.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2187.39,"discounted_cash":1640.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110081","type":"CDM"},{"code":"00046110081","type":"NDC"}],"standard_charges":[{"gross_charge":29.16,"discounted_cash":21.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110281","type":"CDM"},{"code":"00046110281","type":"NDC"}],"standard_charges":[{"gross_charge":29.16,"discounted_cash":21.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":96.25,"discounted_cash":72.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052023","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052023","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BCG LIVE INTRAVESICAL FOR SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00052060202","type":"CDM"},{"code":"J9030","type":"HCPCS"},{"code":"00052060202","type":"NDC"}],"standard_charges":[{"gross_charge":1279.35,"discounted_cash":959.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054000713","type":"CDM"},{"code":"00054000713","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054008813","type":"CDM"},{"code":"00054008813","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMCICLOVIR TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054019813","type":"CDM"},{"code":"00054019813","type":"NDC"}],"standard_charges":[{"gross_charge":20.89,"discounted_cash":15.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10.94,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00054350547","type":"CDM"},{"code":"00054350547","type":"NDC"}],"standard_charges":[{"gross_charge":167.29,"discounted_cash":125.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054457125","type":"CDM"},{"code":"00054457125","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LITHIUM CARBONATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054852825","type":"CDM"},{"code":"00054852825","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054855424","type":"CDM"},{"code":"00054855424","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016801","type":"CDM"},{"code":"00056016801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016875","type":"CDM"},{"code":"00056016875","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016901","type":"CDM"},{"code":"00056016901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016975","type":"CDM"},{"code":"00056016975","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017075","type":"CDM"},{"code":"00056017075","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056018801","type":"CDM"},{"code":"00056018801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056018875","type":"CDM"},{"code":"00056018875","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":62.75,"discounted_cash":47.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":385.77,"discounted_cash":289.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1354.81,"discounted_cash":1016.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065039705","type":"CDM"},{"code":"00065039705","type":"NDC"}],"standard_charges":[{"gross_charge":301.63,"discounted_cash":226.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYPROMELLOSE OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00065040872","type":"CDM"},{"code":"00065040872","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OPHTH INJ 40 MG/ML","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"Rx00065054301","type":"CDM"},{"code":"J3300","type":"HCPCS"},{"code":"00065054301","type":"NDC"}],"standard_charges":[{"gross_charge":158.56,"discounted_cash":118.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":424.09,"discounted_cash":318.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":890.69,"discounted_cash":668.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":114.66,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 0.5% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065066505","type":"CDM"},{"code":"00065066505","type":"NDC"}],"standard_charges":[{"gross_charge":696.36,"discounted_cash":522.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00065079515","type":"CDM"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00065079550","type":"CDM"},{"code":"00065079550","type":"NDC"}],"standard_charges":[{"gross_charge":58.46,"discounted_cash":43.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx00067815202","type":"CDM"},{"code":"00067815202","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":9.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VINORELBINE TARTRATE INJ 10 MG/ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069009901","type":"CDM"},{"code":"J9390","type":"HCPCS"},{"code":"00069009901","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":446.39,"discounted_cash":334.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DALTEPARIN SODIUM SOLN PREFILLED SYR 5000 UNIT/0.2ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00069019602","type":"CDM"},{"code":"J1645","type":"HCPCS"},{"code":"00069019602","type":"NDC"}],"standard_charges":[{"gross_charge":100.23,"discounted_cash":75.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069020901","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069020901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00069023401","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069023401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00069023420","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069023420","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":496.2,"discounted_cash":372.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":793.97,"discounted_cash":595.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":793.95,"discounted_cash":595.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13103.16,"discounted_cash":9827.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRASTUZUMAB-QYYP FOR IV SOLN 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069030801","type":"CDM"},{"code":"Q5116","type":"HCPCS"},{"code":"00069030801","type":"NDC"}],"standard_charges":[{"gross_charge":4679.67,"discounted_cash":3509.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3319.05,"discounted_cash":2489.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEGFILGRASTIM-APGF SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00069032401","type":"CDM"},{"code":"Q5122","type":"HCPCS"},{"code":"00069032401","type":"NDC"}],"standard_charges":[{"gross_charge":13439.63,"discounted_cash":10079.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":12376.13,"discounted_cash":9282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00069034405","type":"CDM"},{"code":"90678","type":"HCPCS"},{"code":"00069034405","type":"NDC"}],"standard_charges":[{"gross_charge":2084.58,"discounted_cash":1563.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2611.82,"discounted_cash":1958.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":545.25,"discounted_cash":408.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":545.43,"discounted_cash":409.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2181.02,"discounted_cash":1635.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2181.72,"discounted_cash":1636.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00069154220","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069154220","type":"NDC"}],"standard_charges":[{"gross_charge":439.49,"discounted_cash":329.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-PFIZER IM SUSP PREF SYR 30 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00069239201","type":"CDM"},{"code":"91320","type":"HCPCS"},{"code":"00069239201","type":"NDC"}],"standard_charges":[{"gross_charge":266.5,"discounted_cash":199.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-PFIZER IM SUSP PREF SYR 30 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00069239210","type":"CDM"},{"code":"91320","type":"HCPCS"},{"code":"00069239210","type":"NDC"}],"standard_charges":[{"gross_charge":266.5,"discounted_cash":199.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-PFIZER IM SUSP PREF SYR 30 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00069243210","type":"CDM"},{"code":"91320","type":"HCPCS"},{"code":"00069243210","type":"NDC"}],"standard_charges":[{"gross_charge":241.66,"discounted_cash":181.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":439.49,"discounted_cash":329.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069547102","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069547102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":162.97,"discounted_cash":122.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":163.03,"discounted_cash":122.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":271.72,"discounted_cash":203.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071015540","type":"CDM"},{"code":"00071015540","type":"NDC"}],"standard_charges":[{"gross_charge":50.27,"discounted_cash":37.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071015640","type":"CDM"},{"code":"00071015640","type":"NDC"}],"standard_charges":[{"gross_charge":71.72,"discounted_cash":53.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071036940","type":"CDM"},{"code":"00071036940","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071041813","type":"CDM"},{"code":"00071041813","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071041824","type":"CDM"},{"code":"00071041824","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":82.29,"discounted_cash":61.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101468","type":"CDM"},{"code":"00071101468","type":"NDC"}],"standard_charges":[{"gross_charge":74.82,"discounted_cash":56.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3735.82,"discounted_cash":2801.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9091.94,"discounted_cash":6818.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1245.3,"discounted_cash":933.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) FOR INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074368303","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"00074368303","type":"NDC"}],"standard_charges":[{"gross_charge":4643.35,"discounted_cash":3482.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 48 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074612290","type":"CDM"},{"code":"00074612290","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074732713","type":"CDM"},{"code":"00074732713","type":"NDC"}],"standard_charges":[{"gross_charge":30.7,"discounted_cash":23.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00075062101","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":116.84,"discounted_cash":87.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00078043561","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"00078043561","type":"NDC"}],"standard_charges":[{"gross_charge":5087.93,"discounted_cash":3815.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":48.46,"discounted_cash":36.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SUSP 0.25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00078072910","type":"CDM"},{"code":"00078072910","type":"NDC"}],"standard_charges":[{"gross_charge":1672.63,"discounted_cash":1254.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1154.58,"discounted_cash":865.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":18301.43,"discounted_cash":13726.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":27404.98,"discounted_cash":20553.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1229.19,"discounted_cash":921.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OPHTH INJ 40 MG/ML","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"Rx00078089778","type":"CDM"},{"code":"J3300","type":"HCPCS"},{"code":"00078089778","type":"NDC"}],"standard_charges":[{"gross_charge":121.64,"discounted_cash":91.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INCLISIRAN SODIUM SUBCUTANEOUS SOLN PREF SYR 284 MG/1.5ML","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00078100060","type":"CDM"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":14733.57,"discounted_cash":11050.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SECUKINUMAB IV SOLN 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00078116861","type":"CDM"},{"code":"J3247","type":"HCPCS"},{"code":"00078116861","type":"NDC"}],"standard_charges":[{"gross_charge":9419.88,"discounted_cash":7064.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2195.98,"discounted_cash":1646.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00085117701","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085117701","type":"NDC"}],"standard_charges":[{"gross_charge":1016.97,"discounted_cash":762.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00085117705","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085117705","type":"NDC"}],"standard_charges":[{"gross_charge":1016.97,"discounted_cash":762.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TEMOZOLOMIDE FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085138101","type":"CDM"},{"code":"J9328","type":"HCPCS"},{"code":"00085138101","type":"NDC"}],"standard_charges":[{"gross_charge":6576.21,"discounted_cash":4932.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":739.26,"discounted_cash":554.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":636.49,"discounted_cash":477.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN GLARGINE INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00088502101","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088502101","type":"NDC"}],"standard_charges":[{"gross_charge":2095.59,"discounted_cash":1571.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093171401","type":"CDM"},{"code":"00093171401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093171601","type":"CDM"},{"code":"00093171601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx00093202623","type":"CDM"},{"code":"00093202623","type":"NDC"}],"standard_charges":[{"gross_charge":45.59,"discounted_cash":34.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220310","type":"CDM"},{"code":"00093220310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093342601","type":"CDM"},{"code":"00093342601","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093412774","type":"CDM"},{"code":"00093412774","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093417774","type":"CDM"},{"code":"00093417774","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093598527","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00093598527","type":"NDC"}],"standard_charges":[{"gross_charge":949.46,"discounted_cash":712.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3363.93,"discounted_cash":2522.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM RECTAL GEL DELIVERY SYSTEM 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093613932","type":"CDM"},{"code":"00093613932","type":"NDC"}],"standard_charges":[{"gross_charge":1728.18,"discounted_cash":1296.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":14.7,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":36.54,"discounted_cash":27.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093716356","type":"CDM"},{"code":"00093716356","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093716456","type":"CDM"},{"code":"00093716456","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093720298","type":"CDM"},{"code":"00093720298","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx00113000202","type":"CDM"},{"code":"00113000202","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE GEL 0.75%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00115147446","type":"CDM"},{"code":"00115147446","type":"NDC"}],"standard_charges":[{"gross_charge":407.18,"discounted_cash":305.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115169449","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00115169449","type":"NDC"}],"standard_charges":[{"gross_charge":708.61,"discounted_cash":531.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115170001","type":"CDM"},{"code":"00115170001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115180301","type":"CDM"},{"code":"00115180301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115262201","type":"CDM"},{"code":"00115262201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00116200116","type":"CDM"},{"code":"00116200116","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":12.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.7,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121077504","type":"CDM"},{"code":"00121077504","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086505","type":"CDM"},{"code":"00121086505","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086530","type":"CDM"},{"code":"00121086530","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086850","type":"CDM"},{"code":"00121086850","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00121089250","type":"CDM"},{"code":"00121089250","type":"NDC"}],"standard_charges":[{"gross_charge":16.69,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":19.87,"discounted_cash":14.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 5 MG/5ML (BASE EQUIV)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121090204","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121090204","type":"NDC"}],"standard_charges":[{"gross_charge":40.54,"discounted_cash":30.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121090315","type":"CDM"},{"code":"00121090315","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121090340","type":"CDM"},{"code":"00121090340","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121090405","type":"CDM"},{"code":"00121090405","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121090494","type":"CDM"},{"code":"00121090494","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121091400","type":"CDM"},{"code":"00121091400","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.55,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121091805","type":"CDM"},{"code":"00121091805","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121091840","type":"CDM"},{"code":"00121091840","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121092816","type":"CDM"},{"code":"00121092816","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121096600","type":"CDM"},{"code":"00121096600","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121096605","type":"CDM"},{"code":"00121096605","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121119000","type":"CDM"},{"code":"00121119000","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121119030","type":"CDM"},{"code":"00121119030","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121127600","type":"CDM"},{"code":"00121127600","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121127610","type":"CDM"},{"code":"00121127610","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121148800","type":"CDM"},{"code":"00121148800","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121155040","type":"CDM"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121159810","type":"CDM"},{"code":"00121159810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121159820","type":"CDM"},{"code":"00121159820","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.54,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121178100","type":"CDM"},{"code":"00121178100","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121178105","type":"CDM"},{"code":"00121178105","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121187000","type":"CDM"},{"code":"00121187000","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121231615","type":"CDM"},{"code":"00121231615","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121231650","type":"CDM"},{"code":"00121231650","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121475905","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121475905","type":"NDC"}],"standard_charges":[{"gross_charge":27.2,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121475950","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121475950","type":"NDC"}],"standard_charges":[{"gross_charge":28.22,"discounted_cash":21.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495040","type":"CDM"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":166.46,"discounted_cash":124.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00132007912","type":"CDM"},{"code":"00132007912","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx00132020140","type":"CDM"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.02,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00135019502","type":"CDM"},{"code":"00135019502","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143117101","type":"CDM"},{"code":"00143117101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143124101","type":"CDM"},{"code":"00143124101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143900601","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"00143900601","type":"NDC"}],"standard_charges":[{"gross_charge":164.63,"discounted_cash":123.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143902201","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00143902201","type":"NDC"}],"standard_charges":[{"gross_charge":398.6,"discounted_cash":298.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143902202","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00143902202","type":"NDC"}],"standard_charges":[{"gross_charge":256.33,"discounted_cash":192.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143908701","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143908701","type":"NDC"}],"standard_charges":[{"gross_charge":984.82,"discounted_cash":738.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143909101","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143909101","type":"NDC"}],"standard_charges":[{"gross_charge":210.92,"discounted_cash":158.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":122.72,"discounted_cash":92.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915201","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915201","type":"NDC"}],"standard_charges":[{"gross_charge":121.02,"discounted_cash":90.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915210","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915301","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915310","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143917201","type":"CDM"},{"code":"00143917201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143917210","type":"CDM"},{"code":"00143917210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143918001","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143918001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143918025","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143918025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143921001","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"00143921001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143921010","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"00143921010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BLEOMYCIN SULFATE FOR INJ 30 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143924101","type":"CDM"},{"code":"J9040","type":"HCPCS"},{"code":"00143924101","type":"NDC"}],"standard_charges":[{"gross_charge":230.63,"discounted_cash":172.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143924501","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00143924501","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143924510","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00143924510","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143927301","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00143927301","type":"NDC"}],"standard_charges":[{"gross_charge":482.32,"discounted_cash":361.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143927310","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00143927310","type":"NDC"}],"standard_charges":[{"gross_charge":272.19,"discounted_cash":204.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 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":379.05,"discounted_cash":284.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143930001","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143930001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143930010","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143930010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143931001","type":"CDM"},{"code":"00143931001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143931010","type":"CDM"},{"code":"00143931010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143931501","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143931524","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931524","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143931601","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143931624","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931624","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143931701","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143931724","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931724","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933001","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933010","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143936801","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00143936801","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00143937401","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143937401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00143937410","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143937410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143937601","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00143937601","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143937901","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00143937901","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143937910","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00143937910","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938101","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"00143938101","type":"NDC"}],"standard_charges":[{"gross_charge":121.23,"discounted_cash":90.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938110","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"00143938110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938401","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00143938401","type":"NDC"}],"standard_charges":[{"gross_charge":154.58,"discounted_cash":115.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938501","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"00143938501","type":"NDC"}],"standard_charges":[{"gross_charge":246.13,"discounted_cash":184.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143943101","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00143943101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143943110","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00143943110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":164.63,"discounted_cash":123.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143950801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950801","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950901","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950901","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950910","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950910","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143951001","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00143951001","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00143951101","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00143951101","type":"NDC"}],"standard_charges":[{"gross_charge":207.47,"discounted_cash":155.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143951501","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00143951501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143951525","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00143951525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143951901","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00143951901","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143951910","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00143951910","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143952501","type":"CDM"},{"code":"00143952501","type":"NDC"}],"standard_charges":[{"gross_charge":301.09,"discounted_cash":225.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143952510","type":"CDM"},{"code":"00143952510","type":"NDC"}],"standard_charges":[{"gross_charge":130.17,"discounted_cash":97.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00143953401","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00143953401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00143953410","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00143953410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143955201","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00143955201","type":"NDC"}],"standard_charges":[{"gross_charge":130.08,"discounted_cash":97.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143955401","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00143955401","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143955501","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00143955501","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2701.58,"discounted_cash":2026.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143958601","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143958601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143958625","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143958625","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968101","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968125","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143968410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00143970910","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143970910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143972024","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143972201","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143972224","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972224","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143983701","type":"CDM"},{"code":"00143983701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143987210","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"00143987210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987610","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987610","type":"NDC"}],"standard_charges":[{"gross_charge":337.21,"discounted_cash":252.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":127.79,"discounted_cash":95.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992701","type":"CDM"},{"code":"00143992701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.025%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000315","type":"CDM"},{"code":"00168000315","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE OINT 1%","drug_information":{"unit":28.35,"type":"GM"},"code_information":[{"code":"Rx00168002031","type":"CDM"},{"code":"00168002031","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00168002109","type":"CDM"},{"code":"00168002109","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":113.4,"type":"GM"},"code_information":[{"code":"Rx00168003504","type":"CDM"},{"code":"00168003504","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168008031","type":"CDM"},{"code":"00168008031","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00168011109","type":"CDM"},{"code":"00168011109","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168035705","type":"CDM"},{"code":"00168035705","type":"NDC"}],"standard_charges":[{"gross_charge":37.93,"discounted_cash":28.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168035755","type":"CDM"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":37.93,"discounted_cash":28.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169183311","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169183311","type":"NDC"}],"standard_charges":[{"gross_charge":431.83,"discounted_cash":323.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10523.86,"discounted_cash":7892.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172392660","type":"CDM"},{"code":"00172392660","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173024956","type":"CDM"},{"code":"00173024956","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":0.00018,"type":"GM"},"code_information":[{"code":"Rx00173068220","type":"CDM"},{"code":"00173068220","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":92.75,"discounted_cash":69.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUTICASONE-SALMETEROL AER POWDER BA 250-50 MCG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173069604","type":"CDM"},{"code":"00173069604","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.41,"discounted_cash":25.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":14091.02,"discounted_cash":10568.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":85586.35,"discounted_cash":64189.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SOTROVIMAB IV SOLN 500 MG/8ML (62.5 MG/ML)","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00173090186","type":"CDM"},{"code":"00173090186","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185005501","type":"CDM"},{"code":"00185005501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NABUMETONE TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185014601","type":"CDM"},{"code":"00185014601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185021001","type":"CDM"},{"code":"00185021001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185041560","type":"CDM"},{"code":"00185041560","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":251.56,"discounted_cash":188.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":251.57,"discounted_cash":188.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":31.78,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM CARBONATE LIQUID 54 MG/5ML (ELEMENTAL MG)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00187526701","type":"CDM"},{"code":"00187526701","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.6,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00225081047","type":"CDM"},{"code":"00225081047","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228212710","type":"CDM"},{"code":"00228212710","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228254010","type":"CDM"},{"code":"00228254010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228300311","type":"CDM"},{"code":"00228300311","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM IODIDE ORAL SOLN 1 GM/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00245000331","type":"CDM"},{"code":"00245000331","type":"NDC"}],"standard_charges":[{"gross_charge":46.54,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014760","type":"CDM"},{"code":"00245014760","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245021211","type":"CDM"},{"code":"00245021211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264180032","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264180032","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE INFUSION 3%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264191507","type":"CDM"},{"code":"00264191507","type":"NDC"}],"standard_charges":[{"gross_charge":240.84,"discounted_cash":180.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 2 GM AND DEXTROSE 3% (50 ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00264310511","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00264310511","type":"NDC"}],"standard_charges":[{"gross_charge":120.81,"discounted_cash":90.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264440054","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00264440054","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264751020","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264751020","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264775100","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00264775100","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264780010","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00264780010","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310027539","type":"CDM"},{"code":"00310027539","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310110501","type":"CDM"},{"code":"00310110501","type":"NDC"}],"standard_charges":[{"gross_charge":61.02,"discounted_cash":45.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310110539","type":"CDM"},{"code":"00310110539","type":"NDC"}],"standard_charges":[{"gross_charge":73.41,"discounted_cash":55.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":22487.3,"discounted_cash":16865.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":7332.82,"discounted_cash":5499.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TREMELIMUMAB-ACTL SOLN FOR IV INFUSION 300 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00310453530","type":"CDM"},{"code":"J9347","type":"HCPCS"},{"code":"00310453530","type":"NDC"}],"standard_charges":[{"gross_charge":294438.25,"discounted_cash":220828.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":30553.3,"discounted_cash":22914.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338001718","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001718","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338001748","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338005403","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338005403","type":"CDM"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00338006701","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"00338006701","type":"NDC"}],"standard_charges":[{"gross_charge":2290.45,"discounted_cash":1717.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) IN NACL 0.9% IV SOLN 100 UNIT/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338012612","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00338012612","type":"NDC"}],"standard_charges":[{"gross_charge":166.39,"discounted_cash":124.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACTATED RINGER'S FOR IRRIGATION","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00338013727","type":"CDM"},{"code":"00338013727","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"},{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":178.28,"discounted_cash":133.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338055118","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338055118","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338055118","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338055118","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETIC ACID IRRIGATION SOLN 0.25%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338065604","type":"CDM"},{"code":"00338065604","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00338080704","type":"CDM"},{"code":"00338080704","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN D5W LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338081104","type":"CDM"},{"code":"00338081104","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":104.7,"discounted_cash":78.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G POTASSIUM INJ 60000 UNIT/ML IN DEXTROSE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338102541","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00338102541","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338105548","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 1 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338107302","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00338107302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":186.77,"discounted_cash":140.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338170840","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00338170840","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338170940","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00338170940","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 2.75% IN D5W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338702001","type":"CDM"},{"code":"00338702001","type":"NDC"}],"standard_charges":[{"gross_charge":248.61,"discounted_cash":186.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 2.75% IN D5W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338702006","type":"CDM"},{"code":"00338702006","type":"NDC"}],"standard_charges":[{"gross_charge":248.61,"discounted_cash":186.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 4.25% IN D5W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338702401","type":"CDM"},{"code":"00338702401","type":"NDC"}],"standard_charges":[{"gross_charge":450.6,"discounted_cash":337.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 4.25% IN D5W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338702404","type":"CDM"},{"code":"00338702404","type":"NDC"}],"standard_charges":[{"gross_charge":450.6,"discounted_cash":337.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D15W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338703001","type":"CDM"},{"code":"00338703001","type":"NDC"}],"standard_charges":[{"gross_charge":310.76,"discounted_cash":233.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D15W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338703006","type":"CDM"},{"code":"00338703006","type":"NDC"}],"standard_charges":[{"gross_charge":302.99,"discounted_cash":227.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D15W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338703201","type":"CDM"},{"code":"00338703201","type":"NDC"}],"standard_charges":[{"gross_charge":528.29,"discounted_cash":396.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D15W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338703204","type":"CDM"},{"code":"00338703204","type":"NDC"}],"standard_charges":[{"gross_charge":528.29,"discounted_cash":396.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954302","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338954302","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":185.63,"discounted_cash":139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLORAZEPATE DIPOTASSIUM TAB 3.75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378003001","type":"CDM"},{"code":"00378003001","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378003201","type":"CDM"},{"code":"00378003201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378008001","type":"CDM"},{"code":"00378008001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":72.67,"discounted_cash":54.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":109.26,"discounted_cash":81.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":122.6,"discounted_cash":91.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":183.96,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180777","type":"CDM"},{"code":"00378180777","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378181177","type":"CDM"},{"code":"00378181177","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378312501","type":"CDM"},{"code":"00378312501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378340293","type":"CDM"},{"code":"00378340293","type":"NDC"}],"standard_charges":[{"gross_charge":26.66,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378342201","type":"CDM"},{"code":"00378342201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378510501","type":"CDM"},{"code":"00378510501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00378543135","type":"CDM"},{"code":"00378543135","type":"NDC"}],"standard_charges":[{"gross_charge":392.52,"discounted_cash":294.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378561578","type":"CDM"},{"code":"00378561578","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378563059","type":"CDM"},{"code":"00378563059","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378617301","type":"CDM"},{"code":"00378617301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00378699031","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00378699031","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00378827031","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00378827031","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00378827055","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00378827055","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":15.68,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx00378877035","type":"CDM"},{"code":"00378877035","type":"NDC"}],"standard_charges":[{"gross_charge":651.38,"discounted_cash":488.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378905516","type":"CDM"},{"code":"00378905516","type":"NDC"}],"standard_charges":[{"gross_charge":34.26,"discounted_cash":25.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.88,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910416","type":"CDM"},{"code":"00378910416","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911216","type":"CDM"},{"code":"00378911216","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911293","type":"CDM"},{"code":"00378911293","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911616","type":"CDM"},{"code":"00378911616","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911693","type":"CDM"},{"code":"00378911693","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":128.17,"discounted_cash":96.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":128.17,"discounted_cash":96.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912216","type":"CDM"},{"code":"00378912216","type":"NDC"}],"standard_charges":[{"gross_charge":94.7,"discounted_cash":71.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912298","type":"CDM"},{"code":"00378912298","type":"NDC"}],"standard_charges":[{"gross_charge":95.02,"discounted_cash":71.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912416","type":"CDM"},{"code":"00378912416","type":"NDC"}],"standard_charges":[{"gross_charge":206.05,"discounted_cash":154.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912498","type":"CDM"},{"code":"00378912498","type":"NDC"}],"standard_charges":[{"gross_charge":206.73,"discounted_cash":155.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378967130","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00378967130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENTAFLUOROPROPANE-TETRAFLUOROETHANE AERO SPRAY","drug_information":{"unit":116.0,"type":"ML"},"code_information":[{"code":"Rx00386000802","type":"CDM"},{"code":"00386000802","type":"NDC"}],"standard_charges":[{"gross_charge":31.47,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALUM (AMMONIUM) POWDER","drug_information":{"unit":170.0,"type":"GM"},"code_information":[{"code":"Rx00395004996","type":"CDM"},{"code":"00395004996","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":14.69,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012323","type":"CDM"},{"code":"00406012323","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406511823","type":"CDM"},{"code":"00406511823","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406511862","type":"CDM"},{"code":"00406511862","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406838023","type":"CDM"},{"code":"00406838023","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406838062","type":"CDM"},{"code":"00406838062","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL INJ 180 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00407141120","type":"CDM"},{"code":"Q9965","type":"HCPCS"},{"code":"00407141120","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00407141210","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141210","type":"NDC"}],"standard_charges":[{"gross_charge":92.61,"discounted_cash":69.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00407141220","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141220","type":"NDC"}],"standard_charges":[{"gross_charge":97.86,"discounted_cash":73.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141233","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141233","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00407141359","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141359","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00407141403","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141403","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141451","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141451","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":75.0,"type":"ML"},"code_information":[{"code":"Rx00407141490","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141490","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":79.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":148.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00407222303","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222303","type":"NDC"}],"standard_charges":[{"gross_charge":162.45,"discounted_cash":121.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409000710","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409000710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM IV SOLN 500 MG/20ML (BASE EQUIV)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409002103","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"00409002103","type":"NDC"}],"standard_charges":[{"gross_charge":449.61,"discounted_cash":337.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409002401","type":"CDM"},{"code":"00409002401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409002410","type":"CDM"},{"code":"00409002410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409015224","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015224","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":204.54,"discounted_cash":153.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx00409018125","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018125","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 2 GM/52.6ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":52.6,"type":"ML"},"code_information":[{"code":"Rx00409018201","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018201","type":"NDC"}],"standard_charges":[{"gross_charge":368.34,"discounted_cash":276.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.26,"type":"ML"},"code_information":[{"code":"Rx00409018301","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018301","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.26,"type":"ML"},"code_information":[{"code":"Rx00409018325","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018325","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409018501","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018501","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 20 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409020102","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00409020102","type":"NDC"}],"standard_charges":[{"gross_charge":470.93,"discounted_cash":353.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 80 MG/8ML","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00409020110","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00409020110","type":"NDC"}],"standard_charges":[{"gross_charge":703.36,"discounted_cash":527.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":973.72,"discounted_cash":730.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1962.75,"discounted_cash":1472.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM IV SOLN 100 MG/4ML (BASE EQUIV)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409104501","type":"CDM"},{"code":"J9294","type":"HCPCS"},{"code":"00409104501","type":"NDC"}],"standard_charges":[{"gross_charge":175.48,"discounted_cash":131.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409113403","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409113403","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115901","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115918","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115918","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116018","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116018","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116209","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116209","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116210","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116318","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116318","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00409120901","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409120901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409121521","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409121521","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409121525","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409121525","type":"NDC"}],"standard_charges":[{"gross_charge":106.4,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409127303","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409127303","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128303","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128317","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128317","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128337","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128337","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409132315","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409132315","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409140305","type":"CDM"},{"code":"00409140305","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409140310","type":"CDM"},{"code":"00409140310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141204","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141204","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141234","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141234","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409154110","type":"CDM"},{"code":"00409154110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409156010","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409156010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 80 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409166020","type":"CDM"},{"code":"00409166020","type":"NDC"}],"standard_charges":[{"gross_charge":171.08,"discounted_cash":128.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 80 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409166022","type":"CDM"},{"code":"00409166022","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409170301","type":"CDM"},{"code":"J9049","type":"HCPCS"},{"code":"00409170301","type":"NDC"}],"standard_charges":[{"gross_charge":343.3,"discounted_cash":257.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174610","type":"CDM"},{"code":"00409174610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174910","type":"CDM"},{"code":"00409174910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174970","type":"CDM"},{"code":"00409174970","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409175550","type":"CDM"},{"code":"00409175550","type":"NDC"}],"standard_charges":[{"gross_charge":116.91,"discounted_cash":87.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409177510","type":"CDM"},{"code":"00409177510","type":"NDC"}],"standard_charges":[{"gross_charge":162.75,"discounted_cash":122.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409177540","type":"CDM"},{"code":"00409177540","type":"NDC"}],"standard_charges":[{"gross_charge":147.96,"discounted_cash":110.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189001","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189003","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189003","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189103","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189103","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409189103","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189103","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189113","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189113","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409189113","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189113","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189123","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189123","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409189123","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189123","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189313","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189313","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189323","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189323","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2361.97,"discounted_cash":1771.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409190211","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"00409190211","type":"NDC"}],"standard_charges":[{"gross_charge":401.53,"discounted_cash":301.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 500 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409190301","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"00409190301","type":"NDC"}],"standard_charges":[{"gross_charge":338.61,"discounted_cash":253.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409198503","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409198503","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409198530","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409201105","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409201105","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409201125","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409201125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409201605","type":"CDM"},{"code":"00409201605","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409201610","type":"CDM"},{"code":"00409201610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409205020","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409205020","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205105","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205115","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205115","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM IV SOLN 500 MG/20ML (BASE EQUIV)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409218801","type":"CDM"},{"code":"J9294","type":"HCPCS"},{"code":"00409218801","type":"NDC"}],"standard_charges":[{"gross_charge":449.61,"discounted_cash":337.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409226720","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409226720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409230504","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230504","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409230505","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230505","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230516","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230516","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230517","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230517","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409230550","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230550","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409230555","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230555","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230802","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230802","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230822","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230822","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230849","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230849","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409230850","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230850","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409230869","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230869","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409233924","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409233924","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409233934","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234468","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234468","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 1 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409234632","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234632","type":"NDC"}],"standard_charges":[{"gross_charge":229.21,"discounted_cash":171.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":99.9,"discounted_cash":74.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317818","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317818","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409318202","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409318211","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318211","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409318311","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318311","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409330001","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409330001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409330024","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 80 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409330101","type":"CDM"},{"code":"00409330101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 80 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409330110","type":"CDM"},{"code":"00409330110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 100 MCG/2ML (50 MCG/ML)","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00409338222","type":"CDM"},{"code":"00409338222","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409361311","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409361311","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409372411","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409372411","type":"NDC"}],"standard_charges":[{"gross_charge":135.83,"discounted_cash":101.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409372432","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409372432","type":"NDC"}],"standard_charges":[{"gross_charge":299.96,"discounted_cash":224.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00409379519","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379519","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":208.9,"discounted_cash":156.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CUPRIC CHLORIDE INJ 0.4 MG/ML (ELEMENTAL)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409211","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409409211","type":"NDC"}],"standard_charges":[{"gross_charge":130.4,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426401","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426401","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426411","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426411","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409427816","type":"CDM"},{"code":"00409427816","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409468818","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468818","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409469924","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469924","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409469933","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469933","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409477601","type":"CDM"},{"code":"00409477601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409477610","type":"CDM"},{"code":"00409477610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409488724","type":"CDM"},{"code":"00409488724","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488803","type":"CDM"},{"code":"00409488803","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488806","type":"CDM"},{"code":"00409488806","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488820","type":"CDM"},{"code":"00409488820","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488850","type":"CDM"},{"code":"00409488850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409490311","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409490311","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409493310","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00409493310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":205.38,"discounted_cash":154.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":133.11,"discounted_cash":99.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":120.94,"discounted_cash":90.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555501","type":"CDM"},{"code":"00409555501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555502","type":"CDM"},{"code":"00409555502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555511","type":"CDM"},{"code":"00409555511","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409582011","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409582011","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409610202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409610204","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409610226","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610226","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610226","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610226","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610235","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610235","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610236","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610236","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN LACTOBIONATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409647644","type":"CDM"},{"code":"J1364","type":"HCPCS"},{"code":"00409647644","type":"NDC"}],"standard_charges":[{"gross_charge":141.13,"discounted_cash":105.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN LACTOBIONATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409648201","type":"CDM"},{"code":"J1364","type":"HCPCS"},{"code":"00409648201","type":"NDC"}],"standard_charges":[{"gross_charge":405.07,"discounted_cash":303.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN LACTOBIONATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409648211","type":"CDM"},{"code":"J1364","type":"HCPCS"},{"code":"00409648211","type":"NDC"}],"standard_charges":[{"gross_charge":450.43,"discounted_cash":337.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409650901","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409650901","type":"NDC"}],"standard_charges":[{"gross_charge":514.69,"discounted_cash":386.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653301","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653331","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653331","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653359","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653359","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409658101","type":"CDM"},{"code":"00409658101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409672903","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672903","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML),MAGNESIUM SULFATE IV SOLN 4 GM/100ML (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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409710104","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710104","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409713909","type":"CDM"},{"code":"00409713909","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HETASTARCH (HES /0.7 OR /0.75) 6% IN NACL 0.9% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409724803","type":"CDM"},{"code":"00409724803","type":"NDC"}],"standard_charges":[{"gross_charge":337.95,"discounted_cash":253.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733220","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733220","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733221","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733221","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733349","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733349","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733520","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733521","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733521","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733649","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733649","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733720","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733721","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733721","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733820","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733820","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733821","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733821","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":270.25,"discounted_cash":202.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":122.81,"discounted_cash":92.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":156.14,"discounted_cash":117.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":181.11,"discounted_cash":135.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":161.3,"discounted_cash":120.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792225","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792225","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-A SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409796709","type":"CDM"},{"code":"00409796709","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798436","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798436","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00409798437","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798437","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409812601","type":"CDM"},{"code":"00409812601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409812610","type":"CDM"},{"code":"00409812610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904516","type":"CDM"},{"code":"00409904516","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909345","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909345","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909412","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909412","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909418","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909418","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909425","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00409955849","type":"CDM"},{"code":"00409955849","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISEDRONATE SODIUM TAB 35 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00430047203","type":"CDM"},{"code":"00430047203","type":"NDC"}],"standard_charges":[{"gross_charge":351.5,"discounted_cash":263.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx00430375414","type":"CDM"},{"code":"00430375414","type":"NDC"}],"standard_charges":[{"gross_charge":1421.66,"discounted_cash":1066.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":18.47,"discounted_cash":13.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456040001","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456040001","type":"NDC"}],"standard_charges":[{"gross_charge":1224.12,"discounted_cash":918.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456040010","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456040010","type":"NDC"}],"standard_charges":[{"gross_charge":1180.48,"discounted_cash":885.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":282.93,"discounted_cash":212.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1180.48,"discounted_cash":885.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEBIVOLOL HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456140530","type":"CDM"},{"code":"00456140530","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEBIVOLOL HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456140563","type":"CDM"},{"code":"00456140563","type":"NDC"}],"standard_charges":[{"gross_charge":22.34,"discounted_cash":16.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASENAPINE MALEATE SL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456240511","type":"CDM"},{"code":"00456240511","type":"NDC"}],"standard_charges":[{"gross_charge":83.38,"discounted_cash":62.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":292.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":617.74,"discounted_cash":463.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469321110","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"00469321110","type":"NDC"}],"standard_charges":[{"gross_charge":1084.96,"discounted_cash":813.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469321199","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"00469321199","type":"NDC"}],"standard_charges":[{"gross_charge":443.39,"discounted_cash":332.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00472073556","type":"CDM"},{"code":"00472073556","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00472110556","type":"CDM"},{"code":"00472110556","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.27,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.88,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487930133","type":"CDM"},{"code":"00487930133","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00487950101","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487950101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":19.32,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10.35,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.47,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00517003101","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"00517003101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517037401","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037401","type":"NDC"}],"standard_charges":[{"gross_charge":1284.92,"discounted_cash":963.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517037405","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037405","type":"NDC"}],"standard_charges":[{"gross_charge":510.76,"discounted_cash":383.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INDIGOTINDISULFONATE SODIUM INJ 8 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00517037501","type":"CDM"},{"code":"J9220","type":"HCPCS"},{"code":"00517037501","type":"NDC"}],"standard_charges":[{"gross_charge":921.2,"discounted_cash":690.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":911.86,"discounted_cash":683.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4456.49,"discounted_cash":3342.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":150.14,"discounted_cash":112.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":265.27,"discounted_cash":198.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517096001","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00517096001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517096010","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00517096010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE INJ 1 MG/ML,ATROPINE SULFATE IV SOLN 1 MG/ML,ATROPINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00517100101","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE INJ 1 MG/ML,ATROPINE SULFATE IV SOLN 1 MG/ML,ATROPINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00517100125","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00517102001","type":"CDM"},{"code":"J2599","type":"HCPCS"},{"code":"00517102001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00517102025","type":"CDM"},{"code":"J2599","type":"HCPCS"},{"code":"00517102025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517231001","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517231001","type":"NDC"}],"standard_charges":[{"gross_charge":108.74,"discounted_cash":81.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517231005","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517231005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517232501","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517232501","type":"NDC"}],"standard_charges":[{"gross_charge":122.3,"discounted_cash":91.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517232510","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517232510","type":"NDC"}],"standard_charges":[{"gross_charge":110.9,"discounted_cash":83.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5542.96,"discounted_cash":4157.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE HCL IM SOLN 50 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517560125","type":"CDM"},{"code":"J3410","type":"HCPCS"},{"code":"00517560125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517919101","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00517919101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527131101","type":"CDM"},{"code":"00527131101","type":"NDC"}],"standard_charges":[{"gross_charge":22.23,"discounted_cash":16.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527163201","type":"CDM"},{"code":"00527163201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1551.52,"discounted_cash":1163.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527411637","type":"CDM"},{"code":"00527411637","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.36,"discounted_cash":73.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALUMINUM HYDROXIDE GEL SUSP 320 MG/5ML","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00536009185","type":"CDM"},{"code":"00536009185","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536100836","type":"CDM"},{"code":"00536100836","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536105429","type":"CDM"},{"code":"00536105429","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536106401","type":"CDM"},{"code":"00536106401","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.09,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.09,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536114263","type":"CDM"},{"code":"00536114263","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536114801","type":"CDM"},{"code":"00536114801","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536118297","type":"CDM"},{"code":"00536118297","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER SUPPOS 0.25-88.44%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536118612","type":"CDM"},{"code":"00536118612","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.97,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536123201","type":"CDM"},{"code":"00536123201","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536123441","type":"CDM"},{"code":"00536123441","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536126328","type":"CDM"},{"code":"00536126328","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536127780","type":"CDM"},{"code":"00536127780","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 525 MG/15ML","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00536128736","type":"CDM"},{"code":"00536128736","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx00536129434","type":"CDM"},{"code":"00536129434","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":6.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.51,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZINC OXIDE OINT 20%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536131628","type":"CDM"},{"code":"00536131628","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx00536132197","type":"CDM"},{"code":"00536132197","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536132701","type":"CDM"},{"code":"00536132701","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MENTHOL-METHYL SALICYLATE CREAM","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx00536134957","type":"CDM"},{"code":"00536134957","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536135795","type":"CDM"},{"code":"00536135795","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.8,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5.93,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SALINE NASAL SPRAY 0.65%","drug_information":{"unit":44.0,"type":"ML"},"code_information":[{"code":"Rx00536250676","type":"CDM"},{"code":"00536250676","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536302906","type":"CDM"},{"code":"00536302906","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.69,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.7,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536331301","type":"CDM"},{"code":"00536331301","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPHENIRAMINE MALEATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536346701","type":"CDM"},{"code":"00536346701","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536440801","type":"CDM"},{"code":"00536440801","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZINC OXIDE OINT 20%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536570028","type":"CDM"},{"code":"00536570028","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.94,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.06,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.76,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548540000","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00548540000","type":"NDC"}],"standard_charges":[{"gross_charge":180.39,"discounted_cash":135.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00548560500","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560500","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.41,"discounted_cash":100.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00548970100","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"00548970100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555003302","type":"CDM"},{"code":"00555003302","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555032302","type":"CDM"},{"code":"00555032302","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555060602","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00555060602","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555088602","type":"CDM"},{"code":"00555088602","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":62.51,"discounted_cash":46.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":111.39,"discounted_cash":83.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":510.38,"discounted_cash":382.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780501","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780501","type":"NDC"}],"standard_charges":[{"gross_charge":510.38,"discounted_cash":382.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780505","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780505","type":"NDC"}],"standard_charges":[{"gross_charge":510.41,"discounted_cash":382.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.92,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574007015","type":"CDM"},{"code":"00574007015","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574007030","type":"CDM"},{"code":"00574007030","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHARCOAL ACTIVATED-SORBITOL SUSP","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574012074","type":"CDM"},{"code":"00574012074","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (38 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574050801","type":"CDM"},{"code":"00574050801","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (38 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574050811","type":"CDM"},{"code":"00574050811","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHARCOAL ACTIVATED-SORBITOL SUSP","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052004","type":"CDM"},{"code":"00574052004","type":"NDC"}],"standard_charges":[{"gross_charge":15.98,"discounted_cash":11.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHARCOAL ACTIVATED-SORBITOL SUSP","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052074","type":"CDM"},{"code":"00574052074","type":"NDC"}],"standard_charges":[{"gross_charge":15.02,"discounted_cash":11.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052104","type":"CDM"},{"code":"00574052104","type":"NDC"}],"standard_charges":[{"gross_charge":16.1,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052174","type":"CDM"},{"code":"00574052174","type":"NDC"}],"standard_charges":[{"gross_charge":13.34,"discounted_cash":10.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":257.94,"discounted_cash":193.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00574082001","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00574082001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":762.27,"discounted_cash":571.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574200815","type":"CDM"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":64.89,"discounted_cash":48.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00574402435","type":"CDM"},{"code":"00574402435","type":"NDC"}],"standard_charges":[{"gross_charge":63.95,"discounted_cash":47.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00574402450","type":"CDM"},{"code":"00574402450","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.75,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":48.26,"discounted_cash":36.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574722612","type":"CDM"},{"code":"00574722612","type":"NDC"}],"standard_charges":[{"gross_charge":33.48,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591024101","type":"CDM"},{"code":"00591024101","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591058201","type":"CDM"},{"code":"00591058201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00591207072","type":"CDM"},{"code":"00591207072","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1222.86,"discounted_cash":917.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591247260","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00591247260","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591267911","type":"CDM"},{"code":"00591267911","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":23.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591267930","type":"CDM"},{"code":"00591267930","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE TD GEL 50 MG/5GM (1%)","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00591321726","type":"CDM"},{"code":"00591321726","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE TD GEL 50 MG/5GM (1%)","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00591321730","type":"CDM"},{"code":"00591321730","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":70.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591354160","type":"CDM"},{"code":"00591354160","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1725.07,"discounted_cash":1293.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1265.25,"discounted_cash":948.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":103.07,"discounted_cash":77.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":25.17,"discounted_cash":18.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":41.23,"discounted_cash":30.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":22173.41,"discounted_cash":16630.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCAGON HCL (RDNA) DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597026010","type":"CDM"},{"code":"J1610","type":"HCPCS"},{"code":"00597026010","type":"NDC"}],"standard_charges":[{"gross_charge":1003.55,"discounted_cash":752.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":30.05,"discounted_cash":22.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":31.74,"discounted_cash":23.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603188010","type":"CDM"},{"code":"00603188010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603488621","type":"CDM"},{"code":"00603488621","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603489021","type":"CDM"},{"code":"00603489021","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENOBARBITAL TAB 97.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603516821","type":"CDM"},{"code":"00603516821","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603533921","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00603533921","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603548421","type":"CDM"},{"code":"00603548421","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641039112","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00641039112","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641039137","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00641039137","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":101.32,"discounted_cash":75.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641094831","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641094831","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641094835","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641094835","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641139731","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139731","type":"NDC"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":184.45,"discounted_cash":138.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641255541","type":"CDM"},{"code":"J1165","type":"HCPCS"},{"code":"00641255541","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SODIUM INJ 50 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00641255545","type":"CDM"},{"code":"J1165","type":"HCPCS"},{"code":"00641255545","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641600101","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641600101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641600125","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641600125","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601510","type":"CDM"},{"code":"00641601510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641602001","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641602001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641602010","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641602010","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641602701","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602701","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604825","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604825","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00641605901","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605901","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641608025","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641608025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611610","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641612525","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641613201","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641613201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641613225","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641613225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 20 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641614601","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641614601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 20 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641614625","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641614625","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641616101","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641616101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641616110","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641616110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641616901","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641616901","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641616910","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641616910","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641618401","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641618401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00641619001","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641619001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00641619010","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641619010","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641619401","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00641619401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641619410","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00641619410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00641619501","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00641619501","type":"NDC"}],"standard_charges":[{"gross_charge":101.52,"discounted_cash":76.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00641619520","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00641619520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00641620501","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641620501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00641620510","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641620510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00641621101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641621101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641623101","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"00641623101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641623601","type":"CDM"},{"code":"00641623601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641623610","type":"CDM"},{"code":"00641623610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00641624401","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00641624401","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641624410","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00641624410","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641626501","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641626501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641626510","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641626510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641921701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641921710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921901","type":"CDM"},{"code":"00641921901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921910","type":"CDM"},{"code":"00641921910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00703024101","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00703024101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703291401","type":"CDM"},{"code":"00703291401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703291403","type":"CDM"},{"code":"00703291403","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":232.01,"discounted_cash":174.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703331101","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00703331101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703331104","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00703331104","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703424401","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424401","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 150 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00703424601","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424601","type":"NDC"}],"standard_charges":[{"gross_charge":143.23,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":364.13,"discounted_cash":273.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRINOTECAN HCL INJ 40 MG/2ML (20 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703443211","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00703443211","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":115.43,"discounted_cash":86.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703507503","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00703507503","type":"NDC"}],"standard_charges":[{"gross_charge":113.13,"discounted_cash":84.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703565301","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00703565301","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":184.08,"discounted_cash":138.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013506","type":"CDM"},{"code":"00713013506","type":"NDC"}],"standard_charges":[{"gross_charge":25.37,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013512","type":"CDM"},{"code":"00713013512","type":"NDC"}],"standard_charges":[{"gross_charge":35.92,"discounted_cash":26.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.93,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.6,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BETAMETHASONE VALERATE CREAM 0.1% (BASE EQUIVALENT)","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713032615","type":"CDM"},{"code":"00713032615","type":"NDC"}],"standard_charges":[{"gross_charge":47.89,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.75,"discounted_cash":26.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":47.41,"discounted_cash":35.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":14.5,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE GEL 0.75%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00713063737","type":"CDM"},{"code":"00713063737","type":"NDC"}],"standard_charges":[{"gross_charge":404.14,"discounted_cash":303.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00713065540","type":"CDM"},{"code":"00713065540","type":"NDC"}],"standard_charges":[{"gross_charge":269.65,"discounted_cash":202.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781120501","type":"CDM"},{"code":"00781120501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781139101","type":"CDM"},{"code":"00781139101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781139113","type":"CDM"},{"code":"00781139113","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781207401","type":"CDM"},{"code":"00781207401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781307901","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00781307901","type":"NDC"}],"standard_charges":[{"gross_charge":655.7,"discounted_cash":491.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781307912","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00781307912","type":"NDC"}],"standard_charges":[{"gross_charge":651.02,"discounted_cash":488.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE)","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"Rx00781315401","type":"CDM"},{"code":"Q0138","type":"HCPCS"},{"code":"00781315401","type":"NDC"}],"standard_charges":[{"gross_charge":997.65,"discounted_cash":748.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00781315695","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"00781315695","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":107.38,"discounted_cash":80.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320685","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320685","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781324664","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781324664","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":4163.51,"discounted_cash":3122.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781325603","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781325603","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00781326204","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326204","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00781326995","type":"CDM"},{"code":"00781326995","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781341575","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"00781341575","type":"NDC"}],"standard_charges":[{"gross_charge":100.78,"discounted_cash":75.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":119.85,"discounted_cash":89.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":218.42,"discounted_cash":163.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781345196","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00781345196","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 80 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00781349380","type":"CDM"},{"code":"00781349380","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 80 MCG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00781349395","type":"CDM"},{"code":"00781349395","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781353191","type":"CDM"},{"code":"J9264","type":"HCPCS"},{"code":"00781353191","type":"NDC"}],"standard_charges":[{"gross_charge":4589.08,"discounted_cash":3441.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781353212","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00781353212","type":"NDC"}],"standard_charges":[{"gross_charge":205.01,"discounted_cash":153.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781354010","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781354010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781354025","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781354025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFPODOXIME PROXETIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781543920","type":"CDM"},{"code":"00781543920","type":"NDC"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":17.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1224.65,"discounted_cash":918.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAVOPROST OPHTH SOLN 0.004% (BENZALKONIUM FREE) (BAK FREE)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00781618556","type":"CDM"},{"code":"00781618556","type":"NDC"}],"standard_charges":[{"gross_charge":545.7,"discounted_cash":409.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":937.65,"discounted_cash":703.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":118.82,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781714458","type":"CDM"},{"code":"00781714458","type":"NDC"}],"standard_charges":[{"gross_charge":29.85,"discounted_cash":22.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781714483","type":"CDM"},{"code":"00781714483","type":"NDC"}],"standard_charges":[{"gross_charge":45.48,"discounted_cash":34.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781721606","type":"CDM"},{"code":"00781721606","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781721664","type":"CDM"},{"code":"00781721664","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781808931","type":"CDM"},{"code":"00781808931","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781905370","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00781905370","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781905395","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00781905395","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781905512","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00781905512","type":"NDC"}],"standard_charges":[{"gross_charge":209.23,"discounted_cash":156.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781910985","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781910985","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781910995","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781910995","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781911015","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781911015","type":"NDC"}],"standard_charges":[{"gross_charge":109.21,"discounted_cash":81.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781911188","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781911188","type":"NDC"}],"standard_charges":[{"gross_charge":132.85,"discounted_cash":99.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781911195","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781911195","type":"NDC"}],"standard_charges":[{"gross_charge":155.34,"discounted_cash":116.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781911215","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781911215","type":"NDC"}],"standard_charges":[{"gross_charge":211.83,"discounted_cash":158.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00781921390","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781921390","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00781921395","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781921395","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00781921491","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781921491","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00781921495","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781921495","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781922209","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781922209","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781922291","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781922291","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00781931570","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"00781931570","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781932895","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781932895","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781933746","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00781933746","type":"NDC"}],"standard_charges":[{"gross_charge":267.76,"discounted_cash":200.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940485","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940485","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940495","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940495","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940880","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940880","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940895","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940895","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":500.41,"discounted_cash":375.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832003889","type":"CDM"},{"code":"00832003889","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMANTADINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832011100","type":"CDM"},{"code":"00832011100","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMANTADINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832011103","type":"CDM"},{"code":"00832011103","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMANTADINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832011189","type":"CDM"},{"code":"00832011189","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832030300","type":"CDM"},{"code":"00832030300","type":"NDC"}],"standard_charges":[{"gross_charge":31.97,"discounted_cash":23.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":44.92,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832100811","type":"CDM"},{"code":"00832100811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE TD GEL 50 MG/5GM (1%)","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00832112035","type":"CDM"},{"code":"00832112035","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE TD GEL 50 MG/5GM (1%)","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00832112089","type":"CDM"},{"code":"00832112089","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121189","type":"CDM"},{"code":"00832121189","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121201","type":"CDM"},{"code":"00832121201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121301","type":"CDM"},{"code":"00832121301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121589","type":"CDM"},{"code":"00832121589","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832602000","type":"CDM"},{"code":"00832602000","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904020161","type":"CDM"},{"code":"00904020161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904052060","type":"CDM"},{"code":"00904052060","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASCORBIC ACID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904052360","type":"CDM"},{"code":"00904052360","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OYSTER SHELL CALCIUM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904188361","type":"CDM"},{"code":"00904188361","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VITAMIN A CAP 3 MG (10000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904208560","type":"CDM"},{"code":"00904208560","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.91,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904357161","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904357161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.46,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904404360","type":"CDM"},{"code":"00904404360","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904504661","type":"CDM"},{"code":"00904504661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904515460","type":"CDM"},{"code":"00904515460","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904530909","type":"CDM"},{"code":"00904530909","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.34,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904546092","type":"CDM"},{"code":"00904546092","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552952","type":"CDM"},{"code":"00904552952","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578461","type":"CDM"},{"code":"00904578461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578561","type":"CDM"},{"code":"00904578561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579146","type":"CDM"},{"code":"00904579146","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.21,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600761","type":"CDM"},{"code":"00904600761","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600861","type":"CDM"},{"code":"00904600861","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904605261","type":"CDM"},{"code":"00904605261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.8,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904641292","type":"CDM"},{"code":"00904641292","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.51,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.16,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644161","type":"CDM"},{"code":"00904644161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645361","type":"CDM"},{"code":"00904645361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646161","type":"CDM"},{"code":"00904646161","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":46.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":22.95,"discounted_cash":17.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5.34,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650361","type":"CDM"},{"code":"00904650361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651761","type":"CDM"},{"code":"00904651761","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904653061","type":"CDM"},{"code":"00904653061","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.56,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655761","type":"CDM"},{"code":"00904655761","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655961","type":"CDM"},{"code":"00904655961","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656061","type":"CDM"},{"code":"00904656061","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656460","type":"CDM"},{"code":"00904656460","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657006","type":"CDM"},{"code":"00904657006","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENOBARBITAL TAB 32.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657561","type":"CDM"},{"code":"00904657561","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":23.34,"discounted_cash":17.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":29.06,"discounted_cash":21.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662361","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00904662361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.06,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":18.77,"discounted_cash":14.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904669061","type":"CDM"},{"code":"00904669061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670706","type":"CDM"},{"code":"00904670706","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.33,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904674460","type":"CDM"},{"code":"00904674460","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904680806","type":"CDM"},{"code":"00904680806","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682461","type":"CDM"},{"code":"00904682461","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682561","type":"CDM"},{"code":"00904682561","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904683873","type":"CDM"},{"code":"00904683873","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904685261","type":"CDM"},{"code":"00904685261","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904688210","type":"CDM"},{"code":"00904688210","type":"NDC"}],"standard_charges":[{"gross_charge":285.6,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904688806","type":"CDM"},{"code":"00904688806","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689361","type":"CDM"},{"code":"00904689361","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.57,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.72,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PALIPERIDONE TAB ER 24HR 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693661","type":"CDM"},{"code":"00904693661","type":"NDC"}],"standard_charges":[{"gross_charge":56.28,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 175 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695761","type":"CDM"},{"code":"00904695761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904698520","type":"CDM"},{"code":"00904698520","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699061","type":"CDM"},{"code":"00904699061","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699261","type":"CDM"},{"code":"00904699261","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699860","type":"CDM"},{"code":"00904699860","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700061","type":"CDM"},{"code":"00904700061","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904700635","type":"CDM"},{"code":"00904700635","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702367","type":"CDM"},{"code":"00904702367","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904703587","type":"CDM"},{"code":"00904703587","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705699","type":"CDM"},{"code":"00904705699","type":"NDC"}],"standard_charges":[{"gross_charge":38.55,"discounted_cash":28.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708461","type":"CDM"},{"code":"00904708461","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710310","type":"CDM"},{"code":"00904710310","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00904711341","type":"CDM"},{"code":"00904711341","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00904711393","type":"CDM"},{"code":"00904711393","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":14.87,"discounted_cash":11.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904713572","type":"CDM"},{"code":"00904713572","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714461","type":"CDM"},{"code":"00904714461","type":"NDC"}],"standard_charges":[{"gross_charge":62.83,"discounted_cash":47.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715404","type":"CDM"},{"code":"00904715404","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715504","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"00904715504","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715661","type":"CDM"},{"code":"00904715661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717961","type":"CDM"},{"code":"00904717961","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721761","type":"CDM"},{"code":"00904721761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721861","type":"CDM"},{"code":"00904721861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721961","type":"CDM"},{"code":"00904721961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722761","type":"CDM"},{"code":"00904722761","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722961","type":"CDM"},{"code":"00904722961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904723661","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904723661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904723961","type":"CDM"},{"code":"00904723961","type":"NDC"}],"standard_charges":[{"gross_charge":0.7,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904724468","type":"CDM"},{"code":"00904724468","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACOSAMIDE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904724768","type":"CDM"},{"code":"00904724768","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACTOBACILLUS CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726006","type":"CDM"},{"code":"00904726006","type":"NDC"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727670","type":"CDM"},{"code":"00904727670","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727692","type":"CDM"},{"code":"00904727692","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERROUS SULFATE SOLN 300 MG/5ML (60 MG/5ML ELEMENTAL FE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727741","type":"CDM"},{"code":"00904727741","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERROUS SULFATE SOLN 300 MG/5ML (60 MG/5ML ELEMENTAL FE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727770","type":"CDM"},{"code":"00904727770","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727841","type":"CDM"},{"code":"00904727841","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727870","type":"CDM"},{"code":"00904727870","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.74,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.02,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904729261","type":"CDM"},{"code":"00904729261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730561","type":"CDM"},{"code":"00904730561","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730661","type":"CDM"},{"code":"00904730661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730861","type":"CDM"},{"code":"00904730861","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904732341","type":"CDM"},{"code":"00904732341","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904732370","type":"CDM"},{"code":"00904732370","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904732562","type":"CDM"},{"code":"00904732562","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904732573","type":"CDM"},{"code":"00904732573","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904732961","type":"CDM"},{"code":"00904732961","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904733661","type":"CDM"},{"code":"00904733661","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736061","type":"CDM"},{"code":"00904736061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736261","type":"CDM"},{"code":"00904736261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736706","type":"CDM"},{"code":"00904736706","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736806","type":"CDM"},{"code":"00904736806","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.91,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904738106","type":"CDM"},{"code":"00904738106","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904741061","type":"CDM"},{"code":"00904741061","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM CITRATE SOLN","drug_information":{"unit":148.0,"type":"ML"},"code_information":[{"code":"Rx00904741844","type":"CDM"},{"code":"00904741844","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00904743535","type":"CDM"},{"code":"00904743535","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744761","type":"CDM"},{"code":"00904744761","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00904746151","type":"CDM"},{"code":"00904746151","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00904746188","type":"CDM"},{"code":"00904746188","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904747835","type":"CDM"},{"code":"00904747835","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750504","type":"CDM"},{"code":"00904750504","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SKIN PROTECTANTS MISC - CREAM","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx00904775127","type":"CDM"},{"code":"00904775127","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":226.49,"discounted_cash":169.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944049304","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"00944049304","type":"NDC"}],"standard_charges":[{"gross_charge":226.49,"discounted_cash":169.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":227.23,"discounted_cash":170.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":221.73,"discounted_cash":166.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV FOR SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944265804","type":"CDM"},{"code":"J1566","type":"HCPCS"},{"code":"00944265804","type":"NDC"}],"standard_charges":[{"gross_charge":6540.17,"discounted_cash":4905.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2267.72,"discounted_cash":1700.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3129.32,"discounted_cash":2346.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6258.64,"discounted_cash":4693.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":9387.96,"discounted_cash":7040.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00955100801","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":101.95,"discounted_cash":76.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00955101001","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101001","type":"NDC"}],"standard_charges":[{"gross_charge":130.67,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00955101010","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101010","type":"NDC"}],"standard_charges":[{"gross_charge":131.1,"discounted_cash":98.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00955101510","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101510","type":"NDC"}],"standard_charges":[{"gross_charge":189.35,"discounted_cash":142.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00955172720","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"00955172720","type":"NDC"}],"standard_charges":[{"gross_charge":703.64,"discounted_cash":527.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00990707426","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990707426","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00990710709","type":"CDM"},{"code":"00990710709","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00990713809","type":"CDM"},{"code":"00990713809","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00990771503","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00990771503","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx00990790409","type":"CDM"},{"code":"00990790409","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00990798303","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00990798303","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":386.61,"discounted_cash":289.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":451.89,"discounted_cash":338.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NA CHONDROIT SULF-NA HYALURON PREF SYR 30-22.5 MG/0.75ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx08065183975","type":"CDM"},{"code":"08065183975","type":"NDC"}],"standard_charges":[{"gross_charge":515.26,"discounted_cash":386.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006073035","type":"CDM"},{"code":"10006073035","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006073051","type":"CDM"},{"code":"10006073051","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":571.63,"discounted_cash":428.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":518.43,"discounted_cash":388.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":52.49,"discounted_cash":39.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":52.49,"discounted_cash":39.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":72.02,"discounted_cash":54.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx10019067210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"10019067210","type":"NDC"}],"standard_charges":[{"gross_charge":956.49,"discounted_cash":717.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019094201","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019094201","type":"NDC"}],"standard_charges":[{"gross_charge":2436.83,"discounted_cash":1827.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019095501","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019095501","type":"NDC"}],"standard_charges":[{"gross_charge":2575.66,"discounted_cash":1931.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3301.7,"discounted_cash":2476.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019095616","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019095616","type":"NDC"}],"standard_charges":[{"gross_charge":2095.75,"discounted_cash":1571.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019095701","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"10019095701","type":"NDC"}],"standard_charges":[{"gross_charge":2786.97,"discounted_cash":2090.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10135058001","type":"CDM"},{"code":"10135058001","type":"NDC"}],"standard_charges":[{"gross_charge":28.21,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUTAMBEN-TETRACAINE-BENZOCAINE AEROSOL SPRAY 2-2-14%","drug_information":{"unit":20.0,"type":"GM"},"code_information":[{"code":"Rx10223020103","type":"CDM"},{"code":"10223020103","type":"NDC"}],"standard_charges":[{"gross_charge":550.46,"discounted_cash":412.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":252.7,"discounted_cash":189.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10370010103","type":"CDM"},{"code":"10370010103","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702010001","type":"CDM"},{"code":"10702010001","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.81,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXOCOBALAMIN (ANTIDOTE) FOR IV SOLN 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11704037001","type":"CDM"},{"code":"11704037001","type":"NDC"}],"standard_charges":[{"gross_charge":3584.59,"discounted_cash":2688.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MENTHOL LOZENGE 7.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546062213","type":"CDM"},{"code":"12546062213","type":"NDC"}],"standard_charges":[{"gross_charge":0.6,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12870000101","type":"CDM"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12870000102","type":"CDM"},{"code":"12870000102","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx13533013100","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"13533013100","type":"NDC"}],"standard_charges":[{"gross_charge":148.49,"discounted_cash":111.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx13533013101","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"13533013101","type":"NDC"}],"standard_charges":[{"gross_charge":158.84,"discounted_cash":119.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx13533020020","type":"CDM"},{"code":"13533020020","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":468.42,"discounted_cash":351.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533063111","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"13533063111","type":"NDC"}],"standard_charges":[{"gross_charge":455.07,"discounted_cash":341.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2282.19,"discounted_cash":1711.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":488.73,"discounted_cash":366.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2060.09,"discounted_cash":1545.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5685.62,"discounted_cash":4264.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11371.24,"discounted_cash":8528.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2842.81,"discounted_cash":2132.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009290","type":"CDM"},{"code":"13668009290","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668013301","type":"CDM"},{"code":"13668013301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 5 MG/5ML (BASE EQUIV)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx13925016604","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"13925016604","type":"NDC"}],"standard_charges":[{"gross_charge":33.79,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":268.93,"discounted_cash":201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx14428000944","type":"CDM"},{"code":"14428000944","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789001505","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789001505","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789001507","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789001507","type":"NDC"}],"standard_charges":[{"gross_charge":285.22,"discounted_cash":213.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789011005","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"14789011005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789011008","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"14789011008","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":147.15,"discounted_cash":110.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789022010","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"14789022010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789025007","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789025007","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789025010","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789025010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 500 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx14789090002","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"14789090002","type":"NDC"}],"standard_charges":[{"gross_charge":2282.6,"discounted_cash":1711.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 500 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx14789090007","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"14789090007","type":"NDC"}],"standard_charges":[{"gross_charge":870.47,"discounted_cash":652.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":21719.84,"discounted_cash":16289.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":43213.36,"discounted_cash":32410.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENOBARBITAL TAB 97.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571066801","type":"CDM"},{"code":"16571066801","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571067616","type":"CDM"},{"code":"16571067616","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571067642","type":"CDM"},{"code":"16571067642","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729000201","type":"CDM"},{"code":"16729000201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 45 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002210","type":"CDM"},{"code":"16729002210","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729003510","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729003510","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FINASTERIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729008910","type":"CDM"},{"code":"16729008910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":876.29,"discounted_cash":657.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx16729011408","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"16729011408","type":"NDC"}],"standard_charges":[{"gross_charge":254.26,"discounted_cash":190.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729011431","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729017101","type":"CDM"},{"code":"16729017101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729020001","type":"CDM"},{"code":"16729020001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729020201","type":"CDM"},{"code":"16729020201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729021815","type":"CDM"},{"code":"16729021815","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729024003","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"16729024003","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729024231","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"16729024231","type":"NDC"}],"standard_charges":[{"gross_charge":264.17,"discounted_cash":198.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPOTECAN HCL INJ 4 MG/4ML (BASE EQUIV) (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx16729024331","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"16729024331","type":"NDC"}],"standard_charges":[{"gross_charge":328.82,"discounted_cash":246.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729024711","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729024711","type":"NDC"}],"standard_charges":[{"gross_charge":4188.32,"discounted_cash":3141.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729026231","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"16729026231","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":645.35,"discounted_cash":484.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":418.01,"discounted_cash":313.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729027730","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"16729027730","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx16729028838","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"16729028838","type":"NDC"}],"standard_charges":[{"gross_charge":179.47,"discounted_cash":134.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 600 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx16729029512","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"16729029512","type":"NDC"}],"standard_charges":[{"gross_charge":190.06,"discounted_cash":142.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":232.86,"discounted_cash":174.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx16729033205","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"16729033205","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729043230","type":"CDM"},{"code":"16729043230","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729043293","type":"CDM"},{"code":"16729043293","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729043505","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"16729043505","type":"NDC"}],"standard_charges":[{"gross_charge":212.78,"discounted_cash":159.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":297.28,"discounted_cash":222.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729043631","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"16729043631","type":"NDC"}],"standard_charges":[{"gross_charge":586.52,"discounted_cash":439.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx16729047208","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"16729047208","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx16729047230","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"16729047230","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729050008","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"16729050008","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729050030","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"16729050030","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729050203","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"16729050203","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729050243","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"16729050243","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM IV SOLN 850 MG/34ML (BASE EQUIV)","drug_information":{"unit":34.0,"type":"ML"},"code_information":[{"code":"Rx16729052228","type":"CDM"},{"code":"J9296","type":"HCPCS"},{"code":"16729052228","type":"NDC"}],"standard_charges":[{"gross_charge":5074.46,"discounted_cash":3805.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZOCAINE-MENTHOL AEROSOL 20-0.5%","drug_information":{"unit":56.0,"type":"GM"},"code_information":[{"code":"Rx16864068002","type":"CDM"},{"code":"16864068002","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090011","type":"CDM"},{"code":"17238090011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090030","type":"CDM"},{"code":"17238090030","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090099","type":"CDM"},{"code":"17238090099","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYPROMELLOSE GONIOSCOPIC SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478006412","type":"CDM"},{"code":"17478006412","type":"NDC"}],"standard_charges":[{"gross_charge":25.65,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx17478007031","type":"CDM"},{"code":"17478007031","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478009710","type":"CDM"},{"code":"17478009710","type":"NDC"}],"standard_charges":[{"gross_charge":161.09,"discounted_cash":120.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478010002","type":"CDM"},{"code":"17478010002","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":36.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478010112","type":"CDM"},{"code":"17478010112","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":35.07,"discounted_cash":26.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478020102","type":"CDM"},{"code":"17478020102","type":"NDC"}],"standard_charges":[{"gross_charge":134.1,"discounted_cash":100.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":60.75,"discounted_cash":45.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478021502","type":"CDM"},{"code":"17478021502","type":"NDC"}],"standard_charges":[{"gross_charge":157.99,"discounted_cash":118.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":503.27,"discounted_cash":377.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx17478028435","type":"CDM"},{"code":"17478028435","type":"NDC"}],"standard_charges":[{"gross_charge":129.48,"discounted_cash":97.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478040401","type":"CDM"},{"code":"17478040401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478050101","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"17478050101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478050401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"17478050401","type":"NDC"}],"standard_charges":[{"gross_charge":519.72,"discounted_cash":389.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478050410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"17478050410","type":"NDC"}],"standard_charges":[{"gross_charge":519.72,"discounted_cash":389.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478054005","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"17478054005","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071510","type":"CDM"},{"code":"17478071510","type":"NDC"}],"standard_charges":[{"gross_charge":60.66,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 0.5% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071610","type":"CDM"},{"code":"17478071610","type":"NDC"}],"standard_charges":[{"gross_charge":291.91,"discounted_cash":218.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":83.46,"discounted_cash":62.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL OPHTH GEL 3.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478079225","type":"CDM"},{"code":"17478079225","type":"NDC"}],"standard_charges":[{"gross_charge":83.3,"discounted_cash":62.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478093705","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"17478093705","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx17478095510","type":"CDM"},{"code":"17478095510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":265.29,"discounted_cash":198.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":271.48,"discounted_cash":203.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":270.22,"discounted_cash":202.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLUENZA VIRUS VACCINE SPLIT PF SUSP PREF SYRINGE 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx19515081041","type":"CDM"},{"code":"90656","type":"HCPCS"},{"code":"19515081041","type":"NDC"}],"standard_charges":[{"gross_charge":106.65,"discounted_cash":79.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLUENZA VIRUS VACCINE SPLIT PF SUSP PREF SYRINGE 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx19515081052","type":"CDM"},{"code":"90656","type":"HCPCS"},{"code":"19515081052","type":"NDC"}],"standard_charges":[{"gross_charge":106.65,"discounted_cash":79.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LANOLIN CREAM","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"Rx20451087121","type":"CDM"},{"code":"20451087121","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003200","type":"CDM"},{"code":"20555003200","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":82.84,"discounted_cash":62.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155002401","type":"CDM"},{"code":"23155002401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155002601","type":"CDM"},{"code":"23155002601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155004901","type":"CDM"},{"code":"23155004901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYBURIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155005801","type":"CDM"},{"code":"23155005801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155007101","type":"CDM"},{"code":"23155007101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010205","type":"CDM"},{"code":"23155010205","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155019401","type":"CDM"},{"code":"23155019401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155029032","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029032","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155029042","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":197.03,"discounted_cash":147.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx23155034542","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"23155034542","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155048901","type":"CDM"},{"code":"23155048901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155049742","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155049742","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155050001","type":"CDM"},{"code":"23155050001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx23155060031","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"23155060031","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx23155060041","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"23155060041","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155062031","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"23155062031","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155066131","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"23155066131","type":"NDC"}],"standard_charges":[{"gross_charge":189.61,"discounted_cash":142.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155066142","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"23155066142","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155066203","type":"CDM"},{"code":"23155066203","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx23155068531","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"23155068531","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENALAPRIL MALEATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155070501","type":"CDM"},{"code":"23155070501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155078631","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155078631","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155083301","type":"CDM"},{"code":"23155083301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155091031","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"23155091031","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155091041","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"23155091041","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6.6,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":50.18,"discounted_cash":37.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":44.97,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DICLOFENAC SODIUM OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208045705","type":"CDM"},{"code":"24208045705","type":"NDC"}],"standard_charges":[{"gross_charge":35.97,"discounted_cash":26.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":76.9,"discounted_cash":57.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":38.63,"discounted_cash":28.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":355.37,"discounted_cash":266.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":149.35,"discounted_cash":112.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":125.54,"discounted_cash":94.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SOLN 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208063110","type":"CDM"},{"code":"24208063110","type":"NDC"}],"standard_charges":[{"gross_charge":240.42,"discounted_cash":180.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":199.9,"discounted_cash":149.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":180.38,"discounted_cash":135.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":146.72,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":51.71,"discounted_cash":38.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":210.38,"discounted_cash":157.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":59.13,"discounted_cash":44.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208091055","type":"CDM"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":48.48,"discounted_cash":36.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN W/ DELAYED RELEASE PARTICLES CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338012013","type":"CDM"},{"code":"24338012013","type":"NDC"}],"standard_charges":[{"gross_charge":23.24,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.04,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.04,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979013301","type":"CDM"},{"code":"24979013301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24979015538","type":"CDM"},{"code":"24979015538","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24987026010","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"24987026010","type":"NDC"}],"standard_charges":[{"gross_charge":487.89,"discounted_cash":365.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021005201","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"25021005201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010610","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"25021010610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010720","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"25021010720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010910","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012850","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":151.28,"discounted_cash":113.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 15 (10-5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014499","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"25021014499","type":"NDC"}],"standard_charges":[{"gross_charge":161.26,"discounted_cash":120.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015320","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"25021015320","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015799","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"25021015799","type":"NDC"}],"standard_charges":[{"gross_charge":127.68,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":98.2,"discounted_cash":73.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021017302","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"25021017302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021018466","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018466","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019011","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019011","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019920","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"25021019920","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021020110","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"25021020110","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":200.41,"discounted_cash":150.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021020751","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"25021020751","type":"NDC"}],"standard_charges":[{"gross_charge":176.41,"discounted_cash":132.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021021598","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"25021021598","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021021599","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"25021021599","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021023550","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"25021023550","type":"NDC"}],"standard_charges":[{"gross_charge":115.97,"discounted_cash":86.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":251.88,"discounted_cash":188.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":246.14,"discounted_cash":184.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021025550","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"25021025550","type":"NDC"}],"standard_charges":[{"gross_charge":262.69,"discounted_cash":197.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":212.35,"discounted_cash":159.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":212.35,"discounted_cash":159.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx25021030884","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"25021030884","type":"NDC"}],"standard_charges":[{"gross_charge":684.82,"discounted_cash":513.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021031102","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"25021031102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021032104","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"25021032104","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021040001","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx25021041170","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"25021041170","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021041882","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"25021041882","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":382.62,"discounted_cash":286.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx25021060850","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"25021060850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021068705","type":"CDM"},{"code":"25021068705","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021075110","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"25021075110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021079120","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"25021079120","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021079810","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"25021079810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":139.41,"discounted_cash":104.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081310","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081310","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPOTECAN HCL FOR INJ 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021082406","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"25021082406","type":"NDC"}],"standard_charges":[{"gross_charge":394.16,"discounted_cash":295.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":259.21,"discounted_cash":194.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":259.21,"discounted_cash":194.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021082850","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021082850","type":"NDC"}],"standard_charges":[{"gross_charge":547.63,"discounted_cash":410.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx25021082902","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"25021082902","type":"NDC"}],"standard_charges":[{"gross_charge":2988.07,"discounted_cash":2241.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":389.39,"discounted_cash":292.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":28.1,"discounted_cash":21.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241015504","type":"CDM"},{"code":"27241015504","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241015604","type":"CDM"},{"code":"27241015604","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241019130","type":"CDM"},{"code":"27241019130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR DELAYED RELEASE SUSP PACKET 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241025611","type":"CDM"},{"code":"27241025611","type":"NDC"}],"standard_charges":[{"gross_charge":43.34,"discounted_cash":32.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR DELAYED RELEASE SUSP PACKET 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241025638","type":"CDM"},{"code":"27241025638","type":"NDC"}],"standard_charges":[{"gross_charge":36.74,"discounted_cash":27.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx27808006502","type":"CDM"},{"code":"27808006502","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722013130","type":"CDM"},{"code":"31722013130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722016531","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"31722016531","type":"NDC"}],"standard_charges":[{"gross_charge":123.87,"discounted_cash":92.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722020410","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"31722020410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722020431","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"31722020431","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722023890","type":"CDM"},{"code":"31722023890","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722052901","type":"CDM"},{"code":"31722052901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053201","type":"CDM"},{"code":"31722053201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722077701","type":"CDM"},{"code":"31722077701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722080660","type":"CDM"},{"code":"31722080660","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx31722098131","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"31722098131","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMCICLOVIR TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002607","type":"CDM"},{"code":"33342002607","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342006207","type":"CDM"},{"code":"33342006207","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009302","type":"CDM"},{"code":"33342009302","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009607","type":"CDM"},{"code":"33342009607","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342015611","type":"CDM"},{"code":"33342015611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":41.75,"discounted_cash":31.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000924","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"36000000924","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000004624","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"36000004624","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx36000009210","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"36000009210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx36000016201","type":"CDM"},{"code":"36000016201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx36000016210","type":"CDM"},{"code":"36000016210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx36000028325","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx36000030801","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"36000030801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx36000030810","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37000002404","type":"CDM"},{"code":"37000002404","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.11,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37000002444","type":"CDM"},{"code":"37000002444","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.21,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37864008289","type":"CDM"},{"code":"37864008289","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37864090599","type":"CDM"},{"code":"37864090599","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALUMINUM CHLORIDE POWDER","drug_information":{"unit":500.0,"type":"GM"},"code_information":[{"code":"Rx38779068508","type":"CDM"},{"code":"38779068508","type":"NDC"}],"standard_charges":[{"gross_charge":256.55,"discounted_cash":192.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM PHOSPHATE MONOBASIC TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39328000810","type":"CDM"},{"code":"39328000810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.74,"discounted_cash":10.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.34,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.1,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39423044048","type":"CDM"},{"code":"39423044048","type":"NDC"}],"standard_charges":[{"gross_charge":0.87,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":196.51,"discounted_cash":147.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":376.24,"discounted_cash":282.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx39822100001","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"39822100001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":253.61,"discounted_cash":190.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx39822110001","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":115.88,"discounted_cash":86.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":61.86,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx39822400001","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"39822400001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx39822552502","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"39822552502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx39822552503","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"39822552503","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMMONIA AROMATIC INHALATION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822990001","type":"CDM"},{"code":"39822990001","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CADEXOMER IODINE GEL 0.9%","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"Rx40565012249","type":"CDM"},{"code":"40565012249","type":"NDC"}],"standard_charges":[{"gross_charge":214.61,"discounted_cash":160.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CADEXOMER IODINE GEL 0.9%","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx40565012256","type":"CDM"},{"code":"40565012256","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":51.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx41100082033","type":"CDM"},{"code":"41100082033","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx41167005742","type":"CDM"},{"code":"41167005742","type":"NDC"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPSAICIN CREAM 0.1%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx41167075142","type":"CDM"},{"code":"41167075142","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COLD SORE PRODUCTS - OINTMENT","drug_information":{"unit":7.0,"type":"GM"},"code_information":[{"code":"Rx41388021021","type":"CDM"},{"code":"41388021021","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE HCL NASAL SOLN 0.1%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx42023010301","type":"CDM"},{"code":"42023010301","type":"NDC"}],"standard_charges":[{"gross_charge":1028.89,"discounted_cash":771.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx42023010401","type":"CDM"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011602","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"42023011602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":514.29,"discounted_cash":385.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":135.44,"discounted_cash":101.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023016410","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023016410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx42023016899","type":"CDM"},{"code":"42023016899","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":450.13,"discounted_cash":337.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE IV SOLN 250 MG/50ML (BASE EQ)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx42023062201","type":"CDM"},{"code":"J0582","type":"HCPCS"},{"code":"42023062201","type":"NDC"}],"standard_charges":[{"gross_charge":466.92,"discounted_cash":350.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE IV SOLN 250 MG/50ML (BASE EQ)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx42023062210","type":"CDM"},{"code":"J0582","type":"HCPCS"},{"code":"42023062210","type":"NDC"}],"standard_charges":[{"gross_charge":466.92,"discounted_cash":350.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6.89,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192080201","type":"CDM"},{"code":"42192080201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL OTIC SOLN 0.2% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42195055014","type":"CDM"},{"code":"42195055014","type":"NDC"}],"standard_charges":[{"gross_charge":31.93,"discounted_cash":23.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8128.89,"discounted_cash":6096.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42385095330","type":"CDM"},{"code":"42385095330","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":159.64,"discounted_cash":119.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx42494044201","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494044201","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CITRATE TAB ER 10 MEQ (1080 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543040701","type":"CDM"},{"code":"42543040701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAVOPROST OPHTH SOLN 0.004% (BENZALKONIUM FREE) (BAK FREE)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx42571013027","type":"CDM"},{"code":"42571013027","type":"NDC"}],"standard_charges":[{"gross_charge":197.97,"discounted_cash":148.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":37.14,"discounted_cash":27.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42799012001","type":"CDM"},{"code":"42799012001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806008801","type":"CDM"},{"code":"42806008801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx42806014932","type":"CDM"},{"code":"42806014932","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806079960","type":"CDM"},{"code":"42806079960","type":"NDC"}],"standard_charges":[{"gross_charge":19.29,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030101","type":"CDM"},{"code":"42858030101","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858080301","type":"CDM"},{"code":"42858080301","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858086706","type":"CDM"},{"code":"42858086706","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066001501","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066001501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":652.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066002301","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066002301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066002310","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066002310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43066004101","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"43066004101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43066004125","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"43066004125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43066009025","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"43066009025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":152.81,"discounted_cash":114.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":289.77,"discounted_cash":217.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":267.14,"discounted_cash":200.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43292055540","type":"CDM"},{"code":"43292055540","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCOSAMINE SULFATE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43292055857","type":"CDM"},{"code":"43292055857","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":71.95,"discounted_cash":53.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":224.06,"discounted_cash":168.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386016101","type":"CDM"},{"code":"43386016101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547028810","type":"CDM"},{"code":"43547028810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547033610","type":"CDM"},{"code":"43547033610","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040110","type":"CDM"},{"code":"43547040110","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040610","type":"CDM"},{"code":"43547040610","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547054401","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547054401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547054425","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547054425","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547064001","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547064001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547064025","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547064025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598005011","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"43598005011","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598007811","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598007811","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598007858","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598007858","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":51.94,"discounted_cash":38.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598026202","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"43598026202","type":"NDC"}],"standard_charges":[{"gross_charge":369.15,"discounted_cash":276.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598026211","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"43598026211","type":"NDC"}],"standard_charges":[{"gross_charge":861.99,"discounted_cash":646.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43598026520","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"43598026520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":143.65,"discounted_cash":107.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":475.55,"discounted_cash":356.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598033011","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"43598033011","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598033111","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"43598033111","type":"NDC"}],"standard_charges":[{"gross_charge":680.3,"discounted_cash":510.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598042660","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"43598042660","type":"NDC"}],"standard_charges":[{"gross_charge":135.91,"discounted_cash":101.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.81,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.15,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.05,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.15,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044828","type":"CDM"},{"code":"43598044828","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.71,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.15,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx43598054821","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"43598054821","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx43598054850","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"43598054850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598057901","type":"CDM"},{"code":"43598057901","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598057930","type":"CDM"},{"code":"43598057930","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598058230","type":"CDM"},{"code":"43598058230","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43598058723","type":"CDM"},{"code":"43598058723","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598071901","type":"CDM"},{"code":"43598071901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598072101","type":"CDM"},{"code":"43598072101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598075011","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"43598075011","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598075058","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"43598075058","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598075510","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598075510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598075552","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598075552","type":"NDC"}],"standard_charges":[{"gross_charge":118.85,"discounted_cash":89.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598075710","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598075710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598085911","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"43598085911","type":"NDC"}],"standard_charges":[{"gross_charge":492.86,"discounted_cash":369.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598089116","type":"CDM"},{"code":"43598089116","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598089152","type":"CDM"},{"code":"43598089152","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598093109","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"43598093109","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598093111","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"43598093111","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598098160","type":"CDM"},{"code":"43598098160","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975030410","type":"CDM"},{"code":"43975030410","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975032203","type":"CDM"},{"code":"43975032203","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975032309","type":"CDM"},{"code":"43975032309","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AVELUMAB SOLN FOR IV INFUSION 200 MG/10ML (20 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx44087353501","type":"CDM"},{"code":"J9023","type":"HCPCS"},{"code":"44087353501","type":"NDC"}],"standard_charges":[{"gross_charge":14324.38,"discounted_cash":10743.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567042000","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567042000","type":"NDC"}],"standard_charges":[{"gross_charge":176.58,"discounted_cash":132.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567043624","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"44567043624","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx44567043724","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"44567043724","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":688.67,"discounted_cash":516.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":747.08,"discounted_cash":560.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567050110","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"44567050110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567050201","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"44567050201","type":"NDC"}],"standard_charges":[{"gross_charge":116.59,"discounted_cash":87.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx44567062002","type":"CDM"},{"code":"44567062002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":271.66,"discounted_cash":203.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":186.77,"discounted_cash":140.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":355.54,"discounted_cash":266.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567082010","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"gross_charge":116.6,"discounted_cash":87.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.32,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN OINT 500 UNIT/GM","drug_information":{"unit":14.0,"type":"GM"},"code_information":[{"code":"Rx45802006001","type":"CDM"},{"code":"45802006001","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":38.48,"discounted_cash":28.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL CREAM 1-1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802014464","type":"CDM"},{"code":"45802014464","type":"NDC"}],"standard_charges":[{"gross_charge":468.84,"discounted_cash":351.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx45802020126","type":"CDM"},{"code":"45802020126","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx45802020326","type":"CDM"},{"code":"45802020326","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.54,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx45802041059","type":"CDM"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOTRIMAZOLE CREAM 1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802043411","type":"CDM"},{"code":"45802043411","type":"NDC"}],"standard_charges":[{"gross_charge":4.82,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.7,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.71,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.79,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.71,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802091987","type":"CDM"},{"code":"45802091987","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963070911","type":"CDM"},{"code":"45963070911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":419.54,"discounted_cash":314.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":99.57,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 490-640 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx46287001430","type":"CDM"},{"code":"46287001430","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.39,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMMONIA AROMATIC INHALATION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx46414333303","type":"CDM"},{"code":"46414333303","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335006286","type":"CDM"},{"code":"47335006286","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":55386.7,"discounted_cash":41540.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335023596","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"47335023596","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.94,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335093144","type":"CDM"},{"code":"47335093144","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx47335099301","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1454.89,"discounted_cash":1091.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781001101","type":"CDM"},{"code":"47781001101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx47781010444","type":"CDM"},{"code":"47781010444","type":"NDC"}],"standard_charges":[{"gross_charge":699.55,"discounted_cash":524.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781030301","type":"CDM"},{"code":"47781030301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035511","type":"CDM"},{"code":"47781035511","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":87.36,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042411","type":"CDM"},{"code":"47781042411","type":"NDC"}],"standard_charges":[{"gross_charge":53.54,"discounted_cash":40.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042447","type":"CDM"},{"code":"47781042447","type":"NDC"}],"standard_charges":[{"gross_charge":41.91,"discounted_cash":31.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042611","type":"CDM"},{"code":"47781042611","type":"NDC"}],"standard_charges":[{"gross_charge":95.1,"discounted_cash":71.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042647","type":"CDM"},{"code":"47781042647","type":"NDC"}],"standard_charges":[{"gross_charge":100.15,"discounted_cash":75.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042711","type":"CDM"},{"code":"47781042711","type":"NDC"}],"standard_charges":[{"gross_charge":150.37,"discounted_cash":112.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042747","type":"CDM"},{"code":"47781042747","type":"NDC"}],"standard_charges":[{"gross_charge":83.89,"discounted_cash":62.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042811","type":"CDM"},{"code":"47781042811","type":"NDC"}],"standard_charges":[{"gross_charge":205.45,"discounted_cash":154.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042847","type":"CDM"},{"code":"47781042847","type":"NDC"}],"standard_charges":[{"gross_charge":123.45,"discounted_cash":92.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781046813","type":"CDM"},{"code":"47781046813","type":"NDC"}],"standard_charges":[{"gross_charge":38.57,"discounted_cash":28.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781059707","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"47781059707","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781059791","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"47781059791","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781059807","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"47781059807","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781059891","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"47781059891","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx48102004711","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"48102004711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MINERAL OIL","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx48433020230","type":"CDM"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":139.65,"discounted_cash":104.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRALATREXATE IV INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx48818000101","type":"CDM"},{"code":"J9307","type":"HCPCS"},{"code":"48818000101","type":"NDC"}],"standard_charges":[{"gross_charge":48288.09,"discounted_cash":36216.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNIT/10ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx49281019020","type":"CDM"},{"code":"90376","type":"HCPCS"},{"code":"49281019020","type":"NDC"}],"standard_charges":[{"gross_charge":2911.54,"discounted_cash":2183.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNIT/10ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx49281019058","type":"CDM"},{"code":"90376","type":"HCPCS"},{"code":"49281019058","type":"NDC"}],"standard_charges":[{"gross_charge":2719.49,"discounted_cash":2039.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021510","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021510","type":"NDC"}],"standard_charges":[{"gross_charge":494.11,"discounted_cash":370.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":494.11,"discounted_cash":370.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021558","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021558","type":"NDC"}],"standard_charges":[{"gross_charge":494.11,"discounted_cash":370.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":324.22,"discounted_cash":243.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RABIES VIRUS VACCINE, HDC FOR INJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281025051","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"49281025051","type":"NDC"}],"standard_charges":[{"gross_charge":1909.31,"discounted_cash":1431.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281057515","type":"CDM"},{"code":"90380","type":"HCPCS"},{"code":"49281057515","type":"NDC"}],"standard_charges":[{"gross_charge":2840.44,"discounted_cash":2130.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281059010","type":"CDM"},{"code":"90734","type":"HCPCS"},{"code":"49281059010","type":"NDC"}],"standard_charges":[{"gross_charge":1182.24,"discounted_cash":886.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483048112","type":"CDM"},{"code":"49483048112","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483062309","type":"CDM"},{"code":"49483062309","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx49580026806","type":"CDM"},{"code":"49580026806","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROGEN PEROXIDE SOLN 3%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx49580030002","type":"CDM"},{"code":"49580030002","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZIDOVUDINE IV SOLN 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx49702021301","type":"CDM"},{"code":"J3485","type":"HCPCS"},{"code":"49702021301","type":"NDC"}],"standard_charges":[{"gross_charge":198.34,"discounted_cash":148.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZIDOVUDINE IV SOLN 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx49702021326","type":"CDM"},{"code":"J3485","type":"HCPCS"},{"code":"49702021326","type":"NDC"}],"standard_charges":[{"gross_charge":196.15,"discounted_cash":147.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884002101","type":"CDM"},{"code":"49884002101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884002201","type":"CDM"},{"code":"49884002201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":202.6,"discounted_cash":151.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884072703","type":"CDM"},{"code":"49884072703","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CROSS-LINKED HYALURONIC ACID GEL PREFILLED SYRINGE 30 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50016095711","type":"CDM"},{"code":"J7326","type":"HCPCS"},{"code":"50016095711","type":"NDC"}],"standard_charges":[{"gross_charge":5022.63,"discounted_cash":3766.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5.55,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":148.59,"discounted_cash":111.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111056001","type":"CDM"},{"code":"50111056001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111091801","type":"CDM"},{"code":"50111091801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228037990","type":"CDM"},{"code":"50228037990","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228045701","type":"CDM"},{"code":"50228045701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228046501","type":"CDM"},{"code":"50228046501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NABUMETONE TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228046601","type":"CDM"},{"code":"50228046601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALTEPLASE FOR INJ 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004163","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004163","type":"NDC"}],"standard_charges":[{"gross_charge":804.73,"discounted_cash":603.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1074.7,"discounted_cash":806.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":17620.85,"discounted_cash":13215.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6683.96,"discounted_cash":5012.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RITUXIMAB IV SOLN 100 MG/10ML,RITUXIMAB IV SOLN 500 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx50242005306","type":"CDM"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":33419.81,"discounted_cash":25064.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5669.66,"discounted_cash":4252.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BEVACIZUMAB IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx50242006101","type":"CDM"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":22678.54,"discounted_cash":17008.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":61273.21,"discounted_cash":45954.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRASTUZUMAB-HYALURONIDASE-OYSK INJ 600-10000 MG-UNIT/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50242007701","type":"CDM"},{"code":"J9356","type":"HCPCS"},{"code":"50242007701","type":"NDC"}],"standard_charges":[{"gross_charge":33260.79,"discounted_cash":24945.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALTEPLASE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008527","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242008527","type":"NDC"}],"standard_charges":[{"gross_charge":35241.65,"discounted_cash":26431.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE FOR IV SOLN 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008701","type":"CDM"},{"code":"J9354","type":"HCPCS"},{"code":"50242008701","type":"NDC"}],"standard_charges":[{"gross_charge":45413.08,"discounted_cash":34059.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":28383.21,"discounted_cash":21287.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ FOR IV SOLUTION 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242010301","type":"CDM"},{"code":"J9309","type":"HCPCS"},{"code":"50242010301","type":"NDC"}],"standard_charges":[{"gross_charge":28372.84,"discounted_cash":21279.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ FOR IV SOLUTION 140 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242010501","type":"CDM"},{"code":"J9309","type":"HCPCS"},{"code":"50242010501","type":"NDC"}],"standard_charges":[{"gross_charge":132406.2,"discounted_cash":99304.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33226.96,"discounted_cash":24920.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":11087.0,"discounted_cash":8315.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3081.82,"discounted_cash":2311.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5315.95,"discounted_cash":3986.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":10631.91,"discounted_cash":7973.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":48522.67,"discounted_cash":36392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":89698.87,"discounted_cash":67274.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33226.96,"discounted_cash":24920.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3076.99,"discounted_cash":2307.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PERTUZUMAB-TRASTUZ-HYALURON-ZZXF INJ 80 MG-40 MG-2000 UNT/ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50242024501","type":"CDM"},{"code":"J9316","type":"HCPCS"},{"code":"50242024501","type":"NDC"}],"standard_charges":[{"gross_charge":99005.69,"discounted_cash":74254.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PERTUZUMAB-TRASTUZ-HYALURON-ZZXF INJ 60 MG-60 MG-2000 UNT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50242026001","type":"CDM"},{"code":"J9316","type":"HCPCS"},{"code":"50242026001","type":"NDC"}],"standard_charges":[{"gross_charge":66001.14,"discounted_cash":49500.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":179397.72,"discounted_cash":134548.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":82449.65,"discounted_cash":61837.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003711","type":"CDM"},{"code":"50268003711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003715","type":"CDM"},{"code":"50268003715","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAZOLAMIDE CAP ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268004212","type":"CDM"},{"code":"50268004212","type":"NDC"}],"standard_charges":[{"gross_charge":16.81,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005411","type":"CDM"},{"code":"50268005411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005415","type":"CDM"},{"code":"50268005415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006411","type":"CDM"},{"code":"50268006411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006415","type":"CDM"},{"code":"50268006415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007411","type":"CDM"},{"code":"50268007411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008115","type":"CDM"},{"code":"50268008115","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008411","type":"CDM"},{"code":"50268008411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008415","type":"CDM"},{"code":"50268008415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008811","type":"CDM"},{"code":"50268008811","type":"NDC"}],"standard_charges":[{"gross_charge":41.58,"discounted_cash":31.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008815","type":"CDM"},{"code":"50268008815","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008911","type":"CDM"},{"code":"50268008911","type":"NDC"}],"standard_charges":[{"gross_charge":21.57,"discounted_cash":16.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008915","type":"CDM"},{"code":"50268008915","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011011","type":"CDM"},{"code":"50268011011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011015","type":"CDM"},{"code":"50268011015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014211","type":"CDM"},{"code":"50268014211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015115","type":"CDM"},{"code":"50268015115","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016311","type":"CDM"},{"code":"50268016311","type":"NDC"}],"standard_charges":[{"gross_charge":13.96,"discounted_cash":10.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016315","type":"CDM"},{"code":"50268016315","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016711","type":"CDM"},{"code":"50268016711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016811","type":"CDM"},{"code":"50268016811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50268018311","type":"CDM"},{"code":"50268018311","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50268018330","type":"CDM"},{"code":"50268018330","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268018411","type":"CDM"},{"code":"50268018411","type":"NDC"}],"standard_charges":[{"gross_charge":28.59,"discounted_cash":21.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268018412","type":"CDM"},{"code":"50268018412","type":"NDC"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268026811","type":"CDM"},{"code":"50268026811","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268026815","type":"CDM"},{"code":"50268026815","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268028111","type":"CDM"},{"code":"50268028111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268028115","type":"CDM"},{"code":"50268028115","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":19.06,"discounted_cash":14.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":19.78,"discounted_cash":14.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031211","type":"CDM"},{"code":"50268031211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031215","type":"CDM"},{"code":"50268031215","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031411","type":"CDM"},{"code":"50268031411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031415","type":"CDM"},{"code":"50268031415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033011","type":"CDM"},{"code":"50268033011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035015","type":"CDM"},{"code":"50268035015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCOSAMINE SULFATE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268037511","type":"CDM"},{"code":"50268037511","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCOSAMINE SULFATE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268037515","type":"CDM"},{"code":"50268037515","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040111","type":"CDM"},{"code":"50268040111","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040115","type":"CDM"},{"code":"50268040115","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040211","type":"CDM"},{"code":"50268040211","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040215","type":"CDM"},{"code":"50268040215","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040511","type":"CDM"},{"code":"50268040511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040515","type":"CDM"},{"code":"50268040515","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040711","type":"CDM"},{"code":"50268040711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040715","type":"CDM"},{"code":"50268040715","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268044911","type":"CDM"},{"code":"50268044911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268044915","type":"CDM"},{"code":"50268044915","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047611","type":"CDM"},{"code":"50268047611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048911","type":"CDM"},{"code":"50268048911","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050511","type":"CDM"},{"code":"50268050511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052011","type":"CDM"},{"code":"50268052011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052015","type":"CDM"},{"code":"50268052015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052711","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"50268052711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052715","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"50268052715","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053415","type":"CDM"},{"code":"50268053415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053511","type":"CDM"},{"code":"50268053511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054111","type":"CDM"},{"code":"50268054111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055011","type":"CDM"},{"code":"50268055011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055711","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"50268055711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055715","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"50268055715","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056211","type":"CDM"},{"code":"50268056211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057511","type":"CDM"},{"code":"50268057511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057515","type":"CDM"},{"code":"50268057515","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.84,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059511","type":"CDM"},{"code":"50268059511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059515","type":"CDM"},{"code":"50268059515","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060311","type":"CDM"},{"code":"50268060311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060411","type":"CDM"},{"code":"50268060411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061011","type":"CDM"},{"code":"50268061011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061015","type":"CDM"},{"code":"50268061015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062311","type":"CDM"},{"code":"50268062311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062315","type":"CDM"},{"code":"50268062315","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062511","type":"CDM"},{"code":"50268062511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062811","type":"CDM"},{"code":"50268062811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062815","type":"CDM"},{"code":"50268062815","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063211","type":"CDM"},{"code":"50268063211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063215","type":"CDM"},{"code":"50268063215","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268064415","type":"CDM"},{"code":"50268064415","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268066411","type":"CDM"},{"code":"50268066411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268066415","type":"CDM"},{"code":"50268066415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268067311","type":"CDM"},{"code":"50268067311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268067315","type":"CDM"},{"code":"50268067315","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068411","type":"CDM"},{"code":"50268068411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068415","type":"CDM"},{"code":"50268068415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072011","type":"CDM"},{"code":"50268072011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072015","type":"CDM"},{"code":"50268072015","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072415","type":"CDM"},{"code":"50268072415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074111","type":"CDM"},{"code":"50268074111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50268074511","type":"CDM"},{"code":"50268074511","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50268074514","type":"CDM"},{"code":"50268074514","type":"NDC"}],"standard_charges":[{"gross_charge":23.02,"discounted_cash":17.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075411","type":"CDM"},{"code":"50268075411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075415","type":"CDM"},{"code":"50268075415","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075711","type":"CDM"},{"code":"50268075711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075715","type":"CDM"},{"code":"50268075715","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076011","type":"CDM"},{"code":"50268076011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERAZOSIN HCL CAP 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076511","type":"CDM"},{"code":"50268076511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERAZOSIN HCL CAP 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076515","type":"CDM"},{"code":"50268076515","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077911","type":"CDM"},{"code":"50268077911","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077915","type":"CDM"},{"code":"50268077915","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268078311","type":"CDM"},{"code":"50268078311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268078315","type":"CDM"},{"code":"50268078315","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268078811","type":"CDM"},{"code":"50268078811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268078815","type":"CDM"},{"code":"50268078815","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268081112","type":"CDM"},{"code":"50268081112","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268087311","type":"CDM"},{"code":"50268087311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268087315","type":"CDM"},{"code":"50268087315","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 5 MG/5ML (BASE EQUIV)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50383004004","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"50383004004","type":"NDC"}],"standard_charges":[{"gross_charge":40.47,"discounted_cash":30.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx50383018902","type":"CDM"},{"code":"50383018902","type":"NDC"}],"standard_charges":[{"gross_charge":390.05,"discounted_cash":292.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383036315","type":"CDM"},{"code":"50383036315","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383036317","type":"CDM"},{"code":"50383036317","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx50383070016","type":"CDM"},{"code":"50383070016","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SYRUP 2 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383074016","type":"CDM"},{"code":"50383074016","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383077110","type":"CDM"},{"code":"50383077110","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383077111","type":"CDM"},{"code":"50383077111","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383080416","type":"CDM"},{"code":"50383080416","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE MICROSPHERES FOR IM EXTENDED REL SUSP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458030601","type":"CDM"},{"code":"J2794","type":"HCPCS"},{"code":"50458030601","type":"NDC"}],"standard_charges":[{"gross_charge":2504.08,"discounted_cash":1878.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2531.58,"discounted_cash":1898.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE MICROSPHERES FOR IM EXTENDED REL SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458030801","type":"CDM"},{"code":"J2794","type":"HCPCS"},{"code":"50458030801","type":"NDC"}],"standard_charges":[{"gross_charge":3455.7,"discounted_cash":2591.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":5065.21,"discounted_cash":3798.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057701","type":"CDM"},{"code":"50458057701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057830","type":"CDM"},{"code":"50458057830","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058030","type":"CDM"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458092510","type":"CDM"},{"code":"50458092510","type":"NDC"}],"standard_charges":[{"gross_charge":114.95,"discounted_cash":86.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1164.48,"discounted_cash":873.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.52,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2196.43,"discounted_cash":1647.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":19918.72,"discounted_cash":14939.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3995.26,"discounted_cash":2996.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742019001","type":"CDM"},{"code":"50742019001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAZOLAMIDE CAP ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742023301","type":"CDM"},{"code":"50742023301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742025701","type":"CDM"},{"code":"50742025701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742036401","type":"CDM"},{"code":"50742036401","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742036430","type":"CDM"},{"code":"50742036430","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742048401","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"50742048401","type":"NDC"}],"standard_charges":[{"gross_charge":122.72,"discounted_cash":92.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":43.28,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":29.29,"discounted_cash":21.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1890.8,"discounted_cash":1418.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742054901","type":"CDM"},{"code":"50742054901","type":"NDC"}],"standard_charges":[{"gross_charge":81.32,"discounted_cash":60.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742054905","type":"CDM"},{"code":"50742054905","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055001","type":"CDM"},{"code":"50742055001","type":"NDC"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":29.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055005","type":"CDM"},{"code":"50742055005","type":"NDC"}],"standard_charges":[{"gross_charge":38.81,"discounted_cash":29.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055201","type":"CDM"},{"code":"50742055201","type":"NDC"}],"standard_charges":[{"gross_charge":96.12,"discounted_cash":72.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055205","type":"CDM"},{"code":"50742055205","type":"NDC"}],"standard_charges":[{"gross_charge":64.71,"discounted_cash":48.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055401","type":"CDM"},{"code":"50742055401","type":"NDC"}],"standard_charges":[{"gross_charge":92.28,"discounted_cash":69.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055405","type":"CDM"},{"code":"50742055405","type":"NDC"}],"standard_charges":[{"gross_charge":76.9,"discounted_cash":57.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742062001","type":"CDM"},{"code":"50742062001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RETIFANLIMAB-DLWR IV SOLN 500 MG/20ML (25 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx50881000603","type":"CDM"},{"code":"J9345","type":"HCPCS"},{"code":"50881000603","type":"NDC"}],"standard_charges":[{"gross_charge":104885.49,"discounted_cash":78664.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":6.57,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"QUINIDINE GLUCONATE TAB ER 324 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002701","type":"CDM"},{"code":"51079002701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"QUINIDINE GLUCONATE TAB ER 324 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002720","type":"CDM"},{"code":"51079002720","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079003520","type":"CDM"},{"code":"51079003520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007420","type":"CDM"},{"code":"51079007420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008620","type":"CDM"},{"code":"51079008620","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079009001","type":"CDM"},{"code":"51079009001","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079009020","type":"CDM"},{"code":"51079009020","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013120","type":"CDM"},{"code":"51079013120","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014520","type":"CDM"},{"code":"51079014520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":40.4,"discounted_cash":30.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":40.4,"discounted_cash":30.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028501","type":"CDM"},{"code":"51079028501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029801","type":"CDM"},{"code":"51079029801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029808","type":"CDM"},{"code":"51079029808","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037501","type":"CDM"},{"code":"51079037501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037520","type":"CDM"},{"code":"51079037520","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038501","type":"CDM"},{"code":"51079038501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038520","type":"CDM"},{"code":"51079038520","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044320","type":"CDM"},{"code":"51079044320","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045120","type":"CDM"},{"code":"51079045120","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079051901","type":"CDM"},{"code":"51079051901","type":"NDC"}],"standard_charges":[{"gross_charge":21.69,"discounted_cash":16.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079051920","type":"CDM"},{"code":"51079051920","type":"NDC"}],"standard_charges":[{"gross_charge":18.57,"discounted_cash":13.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079064401","type":"CDM"},{"code":"51079064401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079064420","type":"CDM"},{"code":"51079064420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072120","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079072120","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072420","type":"CDM"},{"code":"51079072420","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072820","type":"CDM"},{"code":"51079072820","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073301","type":"CDM"},{"code":"51079073301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073320","type":"CDM"},{"code":"51079073320","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078220","type":"CDM"},{"code":"51079078220","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079401","type":"CDM"},{"code":"51079079401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086401","type":"CDM"},{"code":"51079086401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086420","type":"CDM"},{"code":"51079086420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERAZOSIN HCL CAP 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093701","type":"CDM"},{"code":"51079093701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERAZOSIN HCL CAP 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093720","type":"CDM"},{"code":"51079093720","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094301","type":"CDM"},{"code":"51079094301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094320","type":"CDM"},{"code":"51079094320","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":52651.17,"discounted_cash":39488.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144002001","type":"CDM"},{"code":"J9177","type":"HCPCS"},{"code":"51144002001","type":"NDC"}],"standard_charges":[{"gross_charge":19983.96,"discounted_cash":14987.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV FOR IV SOLN 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144003001","type":"CDM"},{"code":"J9177","type":"HCPCS"},{"code":"51144003001","type":"NDC"}],"standard_charges":[{"gross_charge":29975.87,"discounted_cash":22481.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1851.84,"discounted_cash":1388.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001301","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001325","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001325","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51285016288","type":"CDM"},{"code":"51285016288","type":"NDC"}],"standard_charges":[{"gross_charge":40.15,"discounted_cash":30.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293061201","type":"CDM"},{"code":"51293061201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SALSALATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293080301","type":"CDM"},{"code":"51293080301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZOCAINE-MENTHOL AEROSOL 20-0.5%","drug_information":{"unit":78.0,"type":"GM"},"code_information":[{"code":"Rx51409000722","type":"CDM"},{"code":"51409000722","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETIC ACID SOLN 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx51552005506","type":"CDM"},{"code":"51552005506","type":"NDC"}],"standard_charges":[{"gross_charge":103.43,"discounted_cash":77.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE GEL 4-0.05-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.18-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.09-0.5%,LIDOCAINE HCL-RACEPINEPHRINE-TETRACAINE HCL GEL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx51552153601","type":"CDM"},{"code":"51552153601","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":89.11,"discounted_cash":66.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOTRIMAZOLE CREAM 1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672127502","type":"CDM"},{"code":"51672127502","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":50.59,"discounted_cash":37.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOTRIMAZOLE VAGINAL CREAM 1%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx51672200306","type":"CDM"},{"code":"51672200306","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":3.56,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.14,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":1.1,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400205","type":"CDM"},{"code":"51672400205","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672411101","type":"CDM"},{"code":"51672411101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METRONIDAZOLE GEL 0.75%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx51672411606","type":"CDM"},{"code":"51672411606","type":"NDC"}],"standard_charges":[{"gross_charge":409.81,"discounted_cash":307.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672412301","type":"CDM"},{"code":"51672412301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672413304","type":"CDM"},{"code":"51672413304","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx51754010801","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"51754010801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx51754010803","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"51754010803","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":205.98,"discounted_cash":154.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx51754020302","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754020302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx51754100004","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"51754100004","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51754425001","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754425001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 25 MG/5ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 50 MG/10ML-0.9% (5 MG/ML),EPHEDRINE SULFATE PREFILLED SYRINGE 10 MG/2ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 25 MG/5ML (5 MG/ML),EPHEDRINE SULFATE INJ SOLN PREF SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULFATE IV SOLN 5 MG/ML,EPHEDRINE SULFATE PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),EPHEDRINE SULF-NACL SOLN PREF SYR 15 MG/3ML-0.9% (5 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51754425003","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754425003","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51754500101","type":"CDM"},{"code":"51754500101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51754500104","type":"CDM"},{"code":"51754500104","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":38.07,"discounted_cash":28.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":110.51,"discounted_cash":82.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51991014499","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"51991014499","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":14.84,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GRANISETRON HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991073599","type":"CDM"},{"code":"Q0166","type":"HCPCS"},{"code":"51991073599","type":"NDC"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51991098399","type":"CDM"},{"code":"51991098399","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":525.85,"discounted_cash":394.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SOD SULFATE-POT SULF-MG SULF ORAL SOL 17.5-3.13-1.6 GM/177ML","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx52268001201","type":"CDM"},{"code":"52268001201","type":"NDC"}],"standard_charges":[{"gross_charge":245.97,"discounted_cash":184.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":89.94,"discounted_cash":67.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544006554","type":"CDM"},{"code":"52544006554","type":"NDC"}],"standard_charges":[{"gross_charge":28.29,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NORGESTREL & ETHINYL ESTRADIOL TAB 0.3 MG-30 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544084728","type":"CDM"},{"code":"52544084728","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52651000010","type":"CDM"},{"code":"52651000010","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":57.9,"discounted_cash":43.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx53276101002","type":"CDM"},{"code":"53276101002","type":"NDC"}],"standard_charges":[{"gross_charge":1279.03,"discounted_cash":959.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MINERAL OIL ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx53329001311","type":"CDM"},{"code":"53329001311","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53329008986","type":"CDM"},{"code":"53329008986","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53329008987","type":"CDM"},{"code":"53329008987","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":174.98,"discounted_cash":131.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":141.96,"discounted_cash":106.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489055101","type":"CDM"},{"code":"53489055101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746020301","type":"CDM"},{"code":"53746020301","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746051101","type":"CDM"},{"code":"53746051101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746052101","type":"CDM"},{"code":"53746052101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746054401","type":"CDM"},{"code":"53746054401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746054501","type":"CDM"},{"code":"53746054501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746064101","type":"CDM"},{"code":"53746064101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx54288011901","type":"CDM"},{"code":"54288011901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx54288011925","type":"CDM"},{"code":"54288011925","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx54288012001","type":"CDM"},{"code":"54288012001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54288013501","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"54288013501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE HCL NASAL SOLN 0.1%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx54288015401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288015401","type":"NDC"}],"standard_charges":[{"gross_charge":853.49,"discounted_cash":640.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx54288060001","type":"CDM"},{"code":"54288060001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCOSAMINE SULFATE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629007870","type":"CDM"},{"code":"54629007870","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629060101","type":"CDM"},{"code":"54629060101","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMIN IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54643564901","type":"CDM"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMIN IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54643900701","type":"CDM"},{"code":"54643900701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx54879003710","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"54879003710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx54879003725","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"54879003725","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111012601","type":"CDM"},{"code":"55111012601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111014512","type":"CDM"},{"code":"55111014512","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111014571","type":"CDM"},{"code":"55111014571","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111026281","type":"CDM"},{"code":"55111026281","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111027950","type":"CDM"},{"code":"55111027950","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067802","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067810","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067811","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067811","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068002","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068002","type":"NDC"}],"standard_charges":[{"gross_charge":398.09,"discounted_cash":298.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068010","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068010","type":"NDC"}],"standard_charges":[{"gross_charge":210.47,"discounted_cash":157.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068011","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068011","type":"NDC"}],"standard_charges":[{"gross_charge":171.33,"discounted_cash":128.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55111068102","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068102","type":"NDC"}],"standard_charges":[{"gross_charge":274.65,"discounted_cash":205.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55111068507","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"55111068507","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55111068852","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":490.13,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55111069407","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"55111069407","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011310","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011420","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011601","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011620","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011701","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011720","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011930","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012030","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012150","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012215","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"55150012215","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012315","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"55150012315","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012316","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"55150012316","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150012502","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"55150012502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150015410","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx55150015520","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016102","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016205","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016330","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016330","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016505","type":"CDM"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016710","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016910","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017030","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150017301","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx55150017305","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"55150017305","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150017410","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017705","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150018605","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"55150018605","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150018810","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"55150018810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"},{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150019410","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150019830","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150019830","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020200","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"55150020200","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020210","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020720","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150020902","type":"CDM"},{"code":"55150020902","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150022110","type":"CDM"},{"code":"55150022110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55150023200","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023200","type":"NDC"}],"standard_charges":[{"gross_charge":189.41,"discounted_cash":142.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55150023210","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023501","type":"CDM"},{"code":"55150023501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023502","type":"CDM"},{"code":"55150023502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023510","type":"CDM"},{"code":"55150023510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023511","type":"CDM"},{"code":"55150023511","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150023701","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150023701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx55150024251","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"55150024251","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150024647","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"55150024647","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150024747","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"55150024747","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150024950","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150024950","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150025050","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150025050","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025110","type":"CDM"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025220","type":"CDM"},{"code":"55150025220","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025520","type":"CDM"},{"code":"55150025520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx55150025930","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"55150025930","type":"NDC"}],"standard_charges":[{"gross_charge":211.76,"discounted_cash":158.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150026605","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"55150026605","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 1 GM/5ML (200 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150027199","type":"CDM"},{"code":"J9071","type":"HCPCS"},{"code":"55150027199","type":"NDC"}],"standard_charges":[{"gross_charge":837.18,"discounted_cash":627.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150028209","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"55150028209","type":"NDC"}],"standard_charges":[{"gross_charge":172.93,"discounted_cash":129.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150028220","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"gross_charge":172.93,"discounted_cash":129.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029701","type":"CDM"},{"code":"55150029701","type":"NDC"}],"standard_charges":[{"gross_charge":374.67,"discounted_cash":281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029710","type":"CDM"},{"code":"55150029710","type":"NDC"}],"standard_charges":[{"gross_charge":160.73,"discounted_cash":120.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx55150030401","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx55150030425","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROGESTERONE IM IN OIL 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx55150030610","type":"CDM"},{"code":"J2675","type":"HCPCS"},{"code":"55150030610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150030801","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"55150030801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150031801","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"55150031801","type":"NDC"}],"standard_charges":[{"gross_charge":162.37,"discounted_cash":121.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150031825","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"55150031825","type":"NDC"}],"standard_charges":[{"gross_charge":117.04,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150032201","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"55150032201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150032225","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"55150032225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx55150033501","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"55150033501","type":"NDC"}],"standard_charges":[{"gross_charge":182.23,"discounted_cash":136.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150034401","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"55150034401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150034501","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150034501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150034510","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150034510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRINOTECAN HCL INJ 300 MG/15ML (20 MG/ML)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx55150035401","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"55150035401","type":"NDC"}],"standard_charges":[{"gross_charge":252.3,"discounted_cash":189.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150036001","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"55150036001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150036025","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"55150036025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx55150038001","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"55150038001","type":"NDC"}],"standard_charges":[{"gross_charge":703.55,"discounted_cash":527.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 600 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx55150038601","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"55150038601","type":"NDC"}],"standard_charges":[{"gross_charge":271.97,"discounted_cash":203.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150040225","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042701","type":"CDM"},{"code":"55150042701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042710","type":"CDM"},{"code":"55150042710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150043701","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"55150043701","type":"NDC"}],"standard_charges":[{"gross_charge":675.11,"discounted_cash":506.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150045901","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"55150045901","type":"NDC"}],"standard_charges":[{"gross_charge":180.66,"discounted_cash":135.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150045910","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"55150045910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150047101","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"55150047101","type":"NDC"}],"standard_charges":[{"gross_charge":118.89,"discounted_cash":89.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150047110","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"55150047110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx55299060104","type":"CDM"},{"code":"55299060104","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55390056610","type":"CDM"},{"code":"55390056610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN INJ 40 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513000301","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513000301","type":"NDC"}],"standard_charges":[{"gross_charge":1743.83,"discounted_cash":1307.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN INJ 40 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513000304","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513000304","type":"NDC"}],"standard_charges":[{"gross_charge":1794.52,"discounted_cash":1345.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN INJ 60 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513000401","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513000401","type":"NDC"}],"standard_charges":[{"gross_charge":2615.77,"discounted_cash":1961.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN INJ 60 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513000404","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513000404","type":"NDC"}],"standard_charges":[{"gross_charge":2691.78,"discounted_cash":2018.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN INJ 100 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513000501","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513000501","type":"NDC"}],"standard_charges":[{"gross_charge":3008.01,"discounted_cash":2256.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN INJ 100 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513000504","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513000504","type":"NDC"}],"standard_charges":[{"gross_charge":3095.42,"discounted_cash":2321.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN INJ 200 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513000601","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513000601","type":"NDC"}],"standard_charges":[{"gross_charge":6190.85,"discounted_cash":4643.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 100 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55513002504","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"gross_charge":3095.41,"discounted_cash":2321.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 500 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513003201","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":15477.1,"discounted_cash":11607.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 300 MCG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513011101","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":9286.28,"discounted_cash":6964.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRASTUZUMAB-ANNS FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513013201","type":"CDM"},{"code":"Q5117","type":"HCPCS"},{"code":"55513013201","type":"NDC"}],"standard_charges":[{"gross_charge":24458.5,"discounted_cash":18343.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEGFILGRASTIM SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513019001","type":"CDM"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":28190.09,"discounted_cash":21142.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEGFILGRASTIM SOLN PREFILL SYR/INFUSION DEV 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513019201","type":"CDM"},{"code":"J2506","type":"HCPCS"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"gross_charge":28180.86,"discounted_cash":21135.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BEVACIZUMAB-AWWB IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx55513020601","type":"CDM"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":4481.27,"discounted_cash":3360.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BEVACIZUMAB-AWWB IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx55513020701","type":"CDM"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":17924.87,"discounted_cash":13443.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 250 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022101","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":11962.52,"discounted_cash":8971.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022201","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022201","type":"NDC"}],"standard_charges":[{"gross_charge":23924.95,"discounted_cash":17943.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071001","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"gross_charge":7507.83,"discounted_cash":5630.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071021","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":7510.28,"discounted_cash":5632.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DENOSUMAB INJ 120 MG/1.7ML","drug_information":{"unit":1.7,"type":"ML"},"code_information":[{"code":"Rx55513073001","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":13813.34,"discounted_cash":10360.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513088002","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"gross_charge":11423.31,"discounted_cash":8567.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANITUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55513095401","type":"CDM"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":11871.78,"discounted_cash":8903.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANITUMUMAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx55513095601","type":"CDM"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":47487.29,"discounted_cash":35615.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513099802","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":11423.31,"discounted_cash":8567.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx55566220000","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"55566220000","type":"NDC"}],"standard_charges":[{"gross_charge":136.42,"discounted_cash":102.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEGARELIX ACETATE FOR INJ 80 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55566830301","type":"CDM"},{"code":"J9155","type":"HCPCS"},{"code":"55566830301","type":"NDC"}],"standard_charges":[{"gross_charge":3433.93,"discounted_cash":2575.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEGARELIX ACETATE FOR INJ 120 MG/VIAL (240 MG DOSE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55566840301","type":"CDM"},{"code":"J9155","type":"HCPCS"},{"code":"55566840301","type":"NDC"}],"standard_charges":[{"gross_charge":4994.48,"discounted_cash":3745.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237000511","type":"CDM"},{"code":"57237000511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001760","type":"CDM"},{"code":"57237001760","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001890","type":"CDM"},{"code":"57237001890","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001899","type":"CDM"},{"code":"57237001899","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237003001","type":"CDM"},{"code":"57237003001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237003101","type":"CDM"},{"code":"57237003101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237018190","type":"CDM"},{"code":"57237018190","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237021930","type":"CDM"},{"code":"57237021930","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 45 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237022130","type":"CDM"},{"code":"57237022130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx57237031903","type":"CDM"},{"code":"57237031903","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx57237031931","type":"CDM"},{"code":"57237031931","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664037708","type":"CDM"},{"code":"57664037708","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx57664068331","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"57664068331","type":"NDC"}],"standard_charges":[{"gross_charge":224.12,"discounted_cash":168.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx57664068357","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"57664068357","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx57884300201","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"57884300201","type":"NDC"}],"standard_charges":[{"gross_charge":129.31,"discounted_cash":96.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLIXIMAB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57894003001","type":"CDM"},{"code":"J1745","type":"HCPCS"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":4674.28,"discounted_cash":3505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"USTEKINUMAB IV SOLN 130 MG/26ML (5 MG/ML) (FOR IV INFUSION)","drug_information":{"unit":26.0,"type":"ML"},"code_information":[{"code":"Rx57894005427","type":"CDM"},{"code":"J3358","type":"HCPCS"},{"code":"57894005427","type":"NDC"}],"standard_charges":[{"gross_charge":9211.37,"discounted_cash":6908.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"USTEKINUMAB SOLN PREFILLED SYRINGE 90 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx57894006103","type":"CDM"},{"code":"J3357","type":"HCPCS"},{"code":"57894006103","type":"NDC"}],"standard_charges":[{"gross_charge":116700.87,"discounted_cash":87525.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLIXIMAB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57894016001","type":"CDM"},{"code":"J1745","type":"HCPCS"},{"code":"57894016001","type":"NDC"}],"standard_charges":[{"gross_charge":2755.51,"discounted_cash":2066.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GOLIMUMAB IV SOLN 50 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx57894035001","type":"CDM"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":7999.26,"discounted_cash":5999.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx57894050205","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050205","type":"NDC"}],"standard_charges":[{"gross_charge":5518.01,"discounted_cash":4138.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57894050220","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050220","type":"NDC"}],"standard_charges":[{"gross_charge":20925.19,"discounted_cash":15693.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DARATUMUMAB-HYALURONIDASE-FIHJ INJ 1800-30000 MG-UNIT/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx57894050301","type":"CDM"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":74834.86,"discounted_cash":56126.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896045401","type":"CDM"},{"code":"57896045401","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896062101","type":"CDM"},{"code":"57896062101","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896074206","type":"CDM"},{"code":"57896074206","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DALBAVANCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57970010001","type":"CDM"},{"code":"J0875","type":"HCPCS"},{"code":"57970010001","type":"NDC"}],"standard_charges":[{"gross_charge":4003.25,"discounted_cash":3002.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082043","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082043","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082052","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":139.16,"discounted_cash":104.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082101","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"58160082101","type":"NDC"}],"standard_charges":[{"gross_charge":408.21,"discounted_cash":306.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082111","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"gross_charge":323.8,"discounted_cash":242.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082143","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"58160082143","type":"NDC"}],"standard_charges":[{"gross_charge":408.21,"discounted_cash":306.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082152","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"gross_charge":323.8,"discounted_cash":242.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082643","type":"CDM"},{"code":"90632","type":"HCPCS"},{"code":"58160082643","type":"NDC"}],"standard_charges":[{"gross_charge":844.31,"discounted_cash":633.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082652","type":"CDM"},{"code":"90632","type":"HCPCS"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"gross_charge":841.54,"discounted_cash":631.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MENINGOCOCCAL (A, C, Y, AND W-135) OLIGO CONJ VAC IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082703","type":"CDM"},{"code":"90733","type":"HCPCS"},{"code":"58160082703","type":"NDC"}],"standard_charges":[{"gross_charge":483.57,"discounted_cash":362.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MENINGOCOCCAL (A, C, Y, AND W-135) OLIGO CONJ VAC IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082730","type":"CDM"},{"code":"90733","type":"HCPCS"},{"code":"58160082730","type":"NDC"}],"standard_charges":[{"gross_charge":668.37,"discounted_cash":501.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084243","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084243","type":"NDC"}],"standard_charges":[{"gross_charge":294.35,"discounted_cash":220.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084252","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":262.43,"discounted_cash":196.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58232403401","type":"CDM"},{"code":"58232403401","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58232403409","type":"CDM"},{"code":"58232403409","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AGALSIDASE BETA FOR IV SOLN 35 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468004001","type":"CDM"},{"code":"J0180","type":"HCPCS"},{"code":"58468004001","type":"NDC"}],"standard_charges":[{"gross_charge":31452.23,"discounted_cash":23589.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AGALSIDASE BETA FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468004101","type":"CDM"},{"code":"J0180","type":"HCPCS"},{"code":"58468004101","type":"NDC"}],"standard_charges":[{"gross_charge":4492.42,"discounted_cash":3369.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYLAN G-F 20 INTRA-ARTICULAR SOLN PREFILLED SYR 48 MG/6ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx58468009003","type":"CDM"},{"code":"J7325","type":"HCPCS"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"gross_charge":2741.49,"discounted_cash":2056.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALEMTUZUMAB IV INJ 30 MG/ML (FOR INFUSION)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58468035701","type":"CDM"},{"code":"J0202","type":"HCPCS"},{"code":"58468035701","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALEMTUZUMAB IV INJ 30 MG/ML (FOR INFUSION)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58468035703","type":"CDM"},{"code":"J0202","type":"HCPCS"},{"code":"58468035703","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx58657050004","type":"CDM"},{"code":"58657050004","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx58914017014","type":"CDM"},{"code":"58914017014","type":"NDC"}],"standard_charges":[{"gross_charge":26.21,"discounted_cash":19.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58980041012","type":"CDM"},{"code":"58980041012","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":28.35,"type":"GM"},"code_information":[{"code":"Rx58980082430","type":"CDM"},{"code":"58980082430","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041020","type":"CDM"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"gross_charge":35.26,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011042010","type":"CDM"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"gross_charge":64.05,"discounted_cash":48.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011042020","type":"CDM"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":65.7,"discounted_cash":49.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011044010","type":"CDM"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"gross_charge":109.71,"discounted_cash":82.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011044020","type":"CDM"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"gross_charge":112.48,"discounted_cash":84.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011048020","type":"CDM"},{"code":"59011048020","type":"NDC"}],"standard_charges":[{"gross_charge":196.35,"discounted_cash":147.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000713","type":"CDM"},{"code":"59148000713","type":"NDC"}],"standard_charges":[{"gross_charge":80.21,"discounted_cash":60.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000813","type":"CDM"},{"code":"59148000813","type":"NDC"}],"standard_charges":[{"gross_charge":80.21,"discounted_cash":60.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-S 6MO-4Y-PFIZER IM SUSP 3 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx59267431501","type":"CDM"},{"code":"91318","type":"HCPCS"},{"code":"59267431501","type":"NDC"}],"standard_charges":[{"gross_charge":131.58,"discounted_cash":98.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-S 6MO-4Y-PFIZER IM SUSP 3 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx59267431502","type":"CDM"},{"code":"91318","type":"HCPCS"},{"code":"59267431502","type":"NDC"}],"standard_charges":[{"gross_charge":131.58,"discounted_cash":98.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-S 5-11Y-PFIZER IM SUSP 10 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx59267433101","type":"CDM"},{"code":"91319","type":"HCPCS"},{"code":"59267433101","type":"NDC"}],"standard_charges":[{"gross_charge":176.21,"discounted_cash":132.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-S 5-11Y-PFIZER IM SUSP 10 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx59267433102","type":"CDM"},{"code":"91319","type":"HCPCS"},{"code":"59267433102","type":"NDC"}],"standard_charges":[{"gross_charge":163.87,"discounted_cash":122.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-S 6MO-4Y-PFIZER IM SUSP 3 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx59267442602","type":"CDM"},{"code":"91318","type":"HCPCS"},{"code":"59267442602","type":"NDC"}],"standard_charges":[{"gross_charge":374.89,"discounted_cash":281.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-S 5-11Y-PFIZER IM SUSP 10 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx59267443802","type":"CDM"},{"code":"91319","type":"HCPCS"},{"code":"59267443802","type":"NDC"}],"standard_charges":[{"gross_charge":160.35,"discounted_cash":120.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BECLOMETHASONE DIPROP HFA BREATH ACT INH AER 80 MCG/ACT","drug_information":{"unit":10.6,"type":"GM"},"code_information":[{"code":"Rx59310030480","type":"CDM"},{"code":"59310030480","type":"NDC"}],"standard_charges":[{"gross_charge":1208.85,"discounted_cash":906.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE)","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"Rx59338077501","type":"CDM"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":853.99,"discounted_cash":640.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERRIC SUBSULFATE SOLN 259 MG/GM","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx59365606500","type":"CDM"},{"code":"59365606500","type":"NDC"}],"standard_charges":[{"gross_charge":64.58,"discounted_cash":48.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYPROMELLOSE GONIOSCOPIC SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx59390018213","type":"CDM"},{"code":"59390018213","type":"NDC"}],"standard_charges":[{"gross_charge":7.04,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUORESCEIN W/ PROPARACAINE OPHTH SOLN 0.25-0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx59390020505","type":"CDM"},{"code":"59390020505","type":"NDC"}],"standard_charges":[{"gross_charge":75.23,"discounted_cash":56.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572010201","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"59572010201","type":"NDC"}],"standard_charges":[{"gross_charge":4163.51,"discounted_cash":3122.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LUSPATERCEPT-AAMT FOR SUBCUTANEOUS INJ 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572071101","type":"CDM"},{"code":"J0896","type":"HCPCS"},{"code":"59572071101","type":"NDC"}],"standard_charges":[{"gross_charge":17523.89,"discounted_cash":13142.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LUSPATERCEPT-AAMT FOR SUBCUTANEOUS INJ 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572077501","type":"CDM"},{"code":"J0896","type":"HCPCS"},{"code":"59572077501","type":"NDC"}],"standard_charges":[{"gross_charge":52571.41,"discounted_cash":39428.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROMIDEPSIN FOR IV INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572098401","type":"CDM"},{"code":"J9319","type":"HCPCS"},{"code":"59572098401","type":"NDC"}],"standard_charges":[{"gross_charge":22756.01,"discounted_cash":17067.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx59651002655","type":"CDM"},{"code":"59651002655","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651017401","type":"CDM"},{"code":"59651017401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZELASTINE HCL NASAL SPRAY 0.1% (137 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx59651021430","type":"CDM"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651025601","type":"CDM"},{"code":"59651025601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651029501","type":"CDM"},{"code":"59651029501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651048801","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"59651048801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651086601","type":"CDM"},{"code":"59651086601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPOETIN ALFA INJ 4000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676030400","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676030400","type":"NDC"}],"standard_charges":[{"gross_charge":614.66,"discounted_cash":461.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPOETIN ALFA INJ 4000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676030401","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676030401","type":"NDC"}],"standard_charges":[{"gross_charge":607.83,"discounted_cash":455.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPOETIN ALFA INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676031000","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676031000","type":"NDC"}],"standard_charges":[{"gross_charge":846.73,"discounted_cash":635.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPOETIN ALFA INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676031001","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"gross_charge":837.31,"discounted_cash":627.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPOETIN ALFA INJ 40000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676034000","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676034000","type":"NDC"}],"standard_charges":[{"gross_charge":2310.92,"discounted_cash":1733.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPOETIN ALFA INJ 40000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676034001","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"gross_charge":2311.67,"discounted_cash":1733.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYALURONAN INTRA-ARTICULAR SOLN PREFILLED SYRINGE 30 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx59676036001","type":"CDM"},{"code":"J7324","type":"HCPCS"},{"code":"59676036001","type":"NDC"}],"standard_charges":[{"gross_charge":2773.36,"discounted_cash":2080.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYALURONAN INTRA-ARTICULAR SOLN PREFILLED SYRINGE 88 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx59676082001","type":"CDM"},{"code":"J7327","type":"HCPCS"},{"code":"59676082001","type":"NDC"}],"standard_charges":[{"gross_charge":6004.88,"discounted_cash":4503.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746000106","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59746000106","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746011306","type":"CDM"},{"code":"59746011306","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746011506","type":"CDM"},{"code":"59746011506","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746017106","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"59746017106","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746024860","type":"CDM"},{"code":"59746024860","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERAZOSIN HCL CAP 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746038406","type":"CDM"},{"code":"59746038406","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx59762001601","type":"CDM"},{"code":"59762001601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762007301","type":"CDM"},{"code":"59762007301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762007501","type":"CDM"},{"code":"59762007501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFASALAZINE TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762010405","type":"CDM"},{"code":"59762010405","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx59762033302","type":"CDM"},{"code":"59762033302","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762106101","type":"CDM"},{"code":"59762106101","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASENAPINE MALEATE SL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762201206","type":"CDM"},{"code":"59762201206","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx59762312001","type":"CDM"},{"code":"59762312001","type":"NDC"}],"standard_charges":[{"gross_charge":34.85,"discounted_cash":26.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762330403","type":"CDM"},{"code":"59762330403","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762374001","type":"CDM"},{"code":"59762374001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762374202","type":"CDM"},{"code":"59762374202","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762444003","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59762444003","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500701","type":"CDM"},{"code":"59762500701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60219174802","type":"CDM"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"gross_charge":161.4,"discounted_cash":121.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258000601","type":"CDM"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"gross_charge":0.81,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258000615","type":"CDM"},{"code":"60258000615","type":"NDC"}],"standard_charges":[{"gross_charge":0.82,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM NITRITE INJ 30 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60267031110","type":"CDM"},{"code":"60267031110","type":"NDC"}],"standard_charges":[{"gross_charge":207.65,"discounted_cash":155.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM THIOSULFATE IV SOLN 250 MG/ML (25%)","drug_information":{"unit":1.6,"type":"ML"},"code_information":[{"code":"Rx60267070550","type":"CDM"},{"code":"J0209","type":"HCPCS"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432006547","type":"CDM"},{"code":"60432006547","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432012608","type":"CDM"},{"code":"60432012608","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx60432013108","type":"CDM"},{"code":"60432013108","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432021208","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"60432021208","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SELENIUM SULFIDE LOTION 2.5%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx60432052804","type":"CDM"},{"code":"60432052804","type":"NDC"}],"standard_charges":[{"gross_charge":37.14,"discounted_cash":27.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SELENIUM SULFIDE LOTION 2.5%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx60432052805","type":"CDM"},{"code":"60432052805","type":"NDC"}],"standard_charges":[{"gross_charge":41.39,"discounted_cash":31.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432060616","type":"CDM"},{"code":"60432060616","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505003306","type":"CDM"},{"code":"60505003306","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505008000","type":"CDM"},{"code":"60505008000","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505011200","type":"CDM"},{"code":"60505011200","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PAROXETINE HCL ORAL SUSP 10 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505040205","type":"CDM"},{"code":"60505040205","type":"NDC"}],"standard_charges":[{"gross_charge":36.47,"discounted_cash":27.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60505058204","type":"CDM"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"gross_charge":275.94,"discounted_cash":206.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx60505079300","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079300","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx60505079600","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079600","type":"NDC"}],"standard_charges":[{"gross_charge":112.74,"discounted_cash":84.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx60505079604","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079604","type":"NDC"}],"standard_charges":[{"gross_charge":111.74,"discounted_cash":83.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx60505079800","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079800","type":"NDC"}],"standard_charges":[{"gross_charge":133.17,"discounted_cash":99.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx60505079804","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079804","type":"NDC"}],"standard_charges":[{"gross_charge":132.05,"discounted_cash":99.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx60505082306","type":"CDM"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":308.65,"discounted_cash":231.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx60505082901","type":"CDM"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZELASTINE HCL NASAL SPRAY 0.1% (137 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx60505083305","type":"CDM"},{"code":"60505083305","type":"NDC"}],"standard_charges":[{"gross_charge":90.93,"discounted_cash":68.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx60505084703","type":"CDM"},{"code":"60505084703","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505100302","type":"CDM"},{"code":"60505100302","type":"NDC"}],"standard_charges":[{"gross_charge":264.3,"discounted_cash":198.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505257908","type":"CDM"},{"code":"60505257908","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505258008","type":"CDM"},{"code":"60505258008","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505311000","type":"CDM"},{"code":"60505311000","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMCICLOVIR TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505324703","type":"CDM"},{"code":"60505324703","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBANDRONATE SODIUM IV SOLN 3 MG/3ML (BASE EQUIVALENT)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60505609700","type":"CDM"},{"code":"J1740","type":"HCPCS"},{"code":"60505609700","type":"NDC"}],"standard_charges":[{"gross_charge":415.45,"discounted_cash":311.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505612801","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60505613000","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"60505613000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60505613005","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505613206","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"60505613206","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx60505613207","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"60505613207","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614400","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614400","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614404","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614404","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614500","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614500","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614504","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614504","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614600","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614604","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614700","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614700","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614704","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614900","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505614900","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614904","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505614904","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx60505615600","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx60505615604","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615700","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615700","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615704","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615900","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615900","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615904","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505616900","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"60505616900","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505616901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"60505616901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505619301","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"60505619301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505619600","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"gross_charge":431.96,"discounted_cash":323.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505619604","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":135.6,"discounted_cash":101.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60505622600","type":"CDM"},{"code":"60505622600","type":"NDC"}],"standard_charges":[{"gross_charge":100.01,"discounted_cash":75.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENDAMUSTINE HCL IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx60505622800","type":"CDM"},{"code":"J9036","type":"HCPCS"},{"code":"60505622800","type":"NDC"}],"standard_charges":[{"gross_charge":5940.93,"discounted_cash":4455.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623100","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623105","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505626600","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505626600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505626605","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505626605","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700900","type":"CDM"},{"code":"60505700900","type":"NDC"}],"standard_charges":[{"gross_charge":69.79,"discounted_cash":52.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700902","type":"CDM"},{"code":"60505700902","type":"NDC"}],"standard_charges":[{"gross_charge":69.79,"discounted_cash":52.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706200","type":"CDM"},{"code":"60505706200","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706300","type":"CDM"},{"code":"60505706300","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708100","type":"CDM"},{"code":"60505708100","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708102","type":"CDM"},{"code":"60505708102","type":"NDC"}],"standard_charges":[{"gross_charge":33.81,"discounted_cash":25.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708200","type":"CDM"},{"code":"60505708200","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708202","type":"CDM"},{"code":"60505708202","type":"NDC"}],"standard_charges":[{"gross_charge":72.53,"discounted_cash":54.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708400","type":"CDM"},{"code":"60505708400","type":"NDC"}],"standard_charges":[{"gross_charge":69.43,"discounted_cash":52.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708402","type":"CDM"},{"code":"60505708402","type":"NDC"}],"standard_charges":[{"gross_charge":143.58,"discounted_cash":107.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011301","type":"CDM"},{"code":"60687011301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011311","type":"CDM"},{"code":"60687011311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012201","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012211","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012901","type":"CDM"},{"code":"60687012901","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012911","type":"CDM"},{"code":"60687012911","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014301","type":"CDM"},{"code":"60687014301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014311","type":"CDM"},{"code":"60687014311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014501","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014511","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015201","type":"CDM"},{"code":"60687015201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015211","type":"CDM"},{"code":"60687015211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016301","type":"CDM"},{"code":"60687016301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016311","type":"CDM"},{"code":"60687016311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687017801","type":"CDM"},{"code":"60687017801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687017811","type":"CDM"},{"code":"60687017811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019501","type":"CDM"},{"code":"60687019501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019511","type":"CDM"},{"code":"60687019511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020601","type":"CDM"},{"code":"60687020601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020611","type":"CDM"},{"code":"60687020611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021111","type":"CDM"},{"code":"60687021111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021121","type":"CDM"},{"code":"60687021121","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021501","type":"CDM"},{"code":"60687021501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021511","type":"CDM"},{"code":"60687021511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021701","type":"CDM"},{"code":"60687021701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021711","type":"CDM"},{"code":"60687021711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022901","type":"CDM"},{"code":"60687022901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022911","type":"CDM"},{"code":"60687022911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024201","type":"CDM"},{"code":"60687024201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024211","type":"CDM"},{"code":"60687024211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024511","type":"CDM"},{"code":"60687024511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024565","type":"CDM"},{"code":"60687024565","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687025301","type":"CDM"},{"code":"60687025301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687025311","type":"CDM"},{"code":"60687025311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687027211","type":"CDM"},{"code":"60687027211","type":"NDC"}],"standard_charges":[{"gross_charge":13.43,"discounted_cash":10.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687028311","type":"CDM"},{"code":"60687028311","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":12.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687028394","type":"CDM"},{"code":"60687028394","type":"NDC"}],"standard_charges":[{"gross_charge":18.88,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029301","type":"CDM"},{"code":"60687029301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029311","type":"CDM"},{"code":"60687029311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030411","type":"CDM"},{"code":"60687030411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030421","type":"CDM"},{"code":"60687030421","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687031511","type":"CDM"},{"code":"60687031511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687031521","type":"CDM"},{"code":"60687031521","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032501","type":"CDM"},{"code":"60687032501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032511","type":"CDM"},{"code":"60687032511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687033301","type":"CDM"},{"code":"60687033301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687033311","type":"CDM"},{"code":"60687033311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034501","type":"CDM"},{"code":"60687034501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034511","type":"CDM"},{"code":"60687034511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687035501","type":"CDM"},{"code":"60687035501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687035511","type":"CDM"},{"code":"60687035511","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036901","type":"CDM"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036911","type":"CDM"},{"code":"60687036911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037521","type":"CDM"},{"code":"60687037521","type":"NDC"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":39.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037701","type":"CDM"},{"code":"60687037701","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038911","type":"CDM"},{"code":"60687038911","type":"NDC"}],"standard_charges":[{"gross_charge":27.54,"discounted_cash":20.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038921","type":"CDM"},{"code":"60687038921","type":"NDC"}],"standard_charges":[{"gross_charge":31.51,"discounted_cash":23.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687039001","type":"CDM"},{"code":"60687039001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687039011","type":"CDM"},{"code":"60687039011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx60687039579","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"60687039579","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx60687039583","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040211","type":"CDM"},{"code":"60687040211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040265","type":"CDM"},{"code":"60687040265","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60687040579","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"60687040579","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60687040583","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60687041744","type":"CDM"},{"code":"60687041744","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041801","type":"CDM"},{"code":"60687041801","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041811","type":"CDM"},{"code":"60687041811","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043301","type":"CDM"},{"code":"60687043301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043311","type":"CDM"},{"code":"60687043311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043601","type":"CDM"},{"code":"60687043601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043611","type":"CDM"},{"code":"60687043611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043701","type":"CDM"},{"code":"60687043701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043711","type":"CDM"},{"code":"60687043711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043901","type":"CDM"},{"code":"60687043901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043911","type":"CDM"},{"code":"60687043911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044301","type":"CDM"},{"code":"60687044301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044311","type":"CDM"},{"code":"60687044311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044601","type":"CDM"},{"code":"60687044601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044611","type":"CDM"},{"code":"60687044611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045301","type":"CDM"},{"code":"60687045301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045311","type":"CDM"},{"code":"60687045311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045701","type":"CDM"},{"code":"60687045701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045711","type":"CDM"},{"code":"60687045711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687046401","type":"CDM"},{"code":"60687046401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687046411","type":"CDM"},{"code":"60687046411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048401","type":"CDM"},{"code":"60687048401","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048411","type":"CDM"},{"code":"60687048411","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SPIRONOLACTONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048701","type":"CDM"},{"code":"60687048701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SPIRONOLACTONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048711","type":"CDM"},{"code":"60687048711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049101","type":"CDM"},{"code":"60687049101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049111","type":"CDM"},{"code":"60687049111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049301","type":"CDM"},{"code":"60687049301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049311","type":"CDM"},{"code":"60687049311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050401","type":"CDM"},{"code":"60687050401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050411","type":"CDM"},{"code":"60687050411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687051501","type":"CDM"},{"code":"60687051501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687051511","type":"CDM"},{"code":"60687051511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687053101","type":"CDM"},{"code":"60687053101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687053111","type":"CDM"},{"code":"60687053111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054911","type":"CDM"},{"code":"60687054911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054921","type":"CDM"},{"code":"60687054921","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055801","type":"CDM"},{"code":"60687055801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055811","type":"CDM"},{"code":"60687055811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055901","type":"CDM"},{"code":"60687055901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055911","type":"CDM"},{"code":"60687055911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056201","type":"CDM"},{"code":"60687056201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056211","type":"CDM"},{"code":"60687056211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057901","type":"CDM"},{"code":"60687057901","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057911","type":"CDM"},{"code":"60687057911","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058601","type":"CDM"},{"code":"60687058601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058611","type":"CDM"},{"code":"60687058611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058701","type":"CDM"},{"code":"60687058701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058711","type":"CDM"},{"code":"60687058711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059101","type":"CDM"},{"code":"60687059101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059111","type":"CDM"},{"code":"60687059111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059301","type":"CDM"},{"code":"60687059301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059311","type":"CDM"},{"code":"60687059311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059501","type":"CDM"},{"code":"60687059501","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059511","type":"CDM"},{"code":"60687059511","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060901","type":"CDM"},{"code":"60687060901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060911","type":"CDM"},{"code":"60687060911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687061211","type":"CDM"},{"code":"60687061211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687061221","type":"CDM"},{"code":"60687061221","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062701","type":"CDM"},{"code":"60687062701","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062711","type":"CDM"},{"code":"60687062711","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063011","type":"CDM"},{"code":"60687063011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063021","type":"CDM"},{"code":"60687063021","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063101","type":"CDM"},{"code":"60687063101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063111","type":"CDM"},{"code":"60687063111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064001","type":"CDM"},{"code":"60687064001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064011","type":"CDM"},{"code":"60687064011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064201","type":"CDM"},{"code":"60687064201","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064211","type":"CDM"},{"code":"60687064211","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065511","type":"CDM"},{"code":"60687065511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065521","type":"CDM"},{"code":"60687065521","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066101","type":"CDM"},{"code":"60687066101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066111","type":"CDM"},{"code":"60687066111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066401","type":"CDM"},{"code":"60687066401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066411","type":"CDM"},{"code":"60687066411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066901","type":"CDM"},{"code":"60687066901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066911","type":"CDM"},{"code":"60687066911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067701","type":"CDM"},{"code":"60687067701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067711","type":"CDM"},{"code":"60687067711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068001","type":"CDM"},{"code":"60687068001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068011","type":"CDM"},{"code":"60687068011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068101","type":"CDM"},{"code":"60687068101","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068111","type":"CDM"},{"code":"60687068111","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069101","type":"CDM"},{"code":"60687069101","type":"NDC"}],"standard_charges":[{"gross_charge":27.14,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069111","type":"CDM"},{"code":"60687069111","type":"NDC"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069501","type":"CDM"},{"code":"60687069501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069511","type":"CDM"},{"code":"60687069511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069911","type":"CDM"},{"code":"60687069911","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069921","type":"CDM"},{"code":"60687069921","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070401","type":"CDM"},{"code":"60687070401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070411","type":"CDM"},{"code":"60687070411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071701","type":"CDM"},{"code":"60687071701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071711","type":"CDM"},{"code":"60687071711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071801","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"60687071801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071811","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"60687071811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072111","type":"CDM"},{"code":"60687072111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072121","type":"CDM"},{"code":"60687072121","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072311","type":"CDM"},{"code":"60687072311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072321","type":"CDM"},{"code":"60687072321","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073401","type":"CDM"},{"code":"60687073401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073411","type":"CDM"},{"code":"60687073411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074265","type":"CDM"},{"code":"60687074265","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60687074317","type":"CDM"},{"code":"60687074317","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60687074340","type":"CDM"},{"code":"60687074340","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074601","type":"CDM"},{"code":"60687074601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074611","type":"CDM"},{"code":"60687074611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60687076040","type":"CDM"},{"code":"60687076040","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60687076086","type":"CDM"},{"code":"60687076086","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687077601","type":"CDM"},{"code":"60687077601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687077611","type":"CDM"},{"code":"60687077611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687078201","type":"CDM"},{"code":"60687078201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079501","type":"CDM"},{"code":"60687079501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079511","type":"CDM"},{"code":"60687079511","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687082201","type":"CDM"},{"code":"60687082201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687082211","type":"CDM"},{"code":"60687082211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083601","type":"CDM"},{"code":"60687083601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083611","type":"CDM"},{"code":"60687083611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687084411","type":"CDM"},{"code":"60687084411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687084421","type":"CDM"},{"code":"60687084421","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086001","type":"CDM"},{"code":"60687086001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086011","type":"CDM"},{"code":"60687086011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687088501","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"60687088501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687088511","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"60687088511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758011905","type":"CDM"},{"code":"60758011905","type":"NDC"}],"standard_charges":[{"gross_charge":184.02,"discounted_cash":138.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758018805","type":"CDM"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60758061525","type":"CDM"},{"code":"60758061525","type":"NDC"}],"standard_charges":[{"gross_charge":390.05,"discounted_cash":292.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758080105","type":"CDM"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758080205","type":"CDM"},{"code":"60758080205","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60758090810","type":"CDM"},{"code":"60758090810","type":"NDC"}],"standard_charges":[{"gross_charge":45.24,"discounted_cash":33.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THROMBIN FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60793021505","type":"CDM"},{"code":"60793021505","type":"NDC"}],"standard_charges":[{"gross_charge":237.72,"discounted_cash":178.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60793060002","type":"CDM"},{"code":"J0558","type":"HCPCS"},{"code":"60793060002","type":"NDC"}],"standard_charges":[{"gross_charge":805.04,"discounted_cash":603.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60793060010","type":"CDM"},{"code":"J0558","type":"HCPCS"},{"code":"60793060010","type":"NDC"}],"standard_charges":[{"gross_charge":1410.45,"discounted_cash":1057.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070102","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070102","type":"NDC"}],"standard_charges":[{"gross_charge":1070.51,"discounted_cash":802.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070110","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":1070.86,"discounted_cash":803.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 2400000 UNIT/4ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070204","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070204","type":"NDC"}],"standard_charges":[{"gross_charge":517.42,"discounted_cash":388.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx61269010556","type":"CDM"},{"code":"61269010556","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOTRIMAZOLE VAGINAL CREAM 1%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx61269022063","type":"CDM"},{"code":"61269022063","type":"NDC"}],"standard_charges":[{"gross_charge":5.58,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":14.0,"type":"GM"},"code_information":[{"code":"Rx61269073514","type":"CDM"},{"code":"61269073514","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx61269073556","type":"CDM"},{"code":"61269073556","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314001601","type":"CDM"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":126.08,"discounted_cash":94.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314001910","type":"CDM"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":44.92,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314003002","type":"CDM"},{"code":"61314003002","type":"NDC"}],"standard_charges":[{"gross_charge":83.64,"discounted_cash":62.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314014305","type":"CDM"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.15%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314014405","type":"CDM"},{"code":"61314014405","type":"NDC"}],"standard_charges":[{"gross_charge":641.4,"discounted_cash":481.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020315","type":"CDM"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":175.86,"discounted_cash":131.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020415","type":"CDM"},{"code":"61314020415","type":"NDC"}],"standard_charges":[{"gross_charge":172.49,"discounted_cash":129.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314022605","type":"CDM"},{"code":"61314022605","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314022705","type":"CDM"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx61314031801","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"gross_charge":827.77,"discounted_cash":620.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314035401","type":"CDM"},{"code":"61314035401","type":"NDC"}],"standard_charges":[{"gross_charge":88.16,"discounted_cash":66.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx61314035501","type":"CDM"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61314039601","type":"CDM"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314054701","type":"CDM"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314062810","type":"CDM"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx61314063136","type":"CDM"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":75.28,"discounted_cash":56.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063305","type":"CDM"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063705","type":"CDM"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":133.79,"discounted_cash":100.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx61314064511","type":"CDM"},{"code":"61314064511","type":"NDC"}],"standard_charges":[{"gross_charge":350.92,"discounted_cash":263.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SOLN 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314064610","type":"CDM"},{"code":"61314064610","type":"NDC"}],"standard_charges":[{"gross_charge":358.47,"discounted_cash":268.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314065625","type":"CDM"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"gross_charge":43.93,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 0.5% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314066505","type":"CDM"},{"code":"61314066505","type":"NDC"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314067225","type":"CDM"},{"code":"61314067225","type":"NDC"}],"standard_charges":[{"gross_charge":170.58,"discounted_cash":127.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFACETAMIDE SODIUM OPHTH SOLN 10%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314070101","type":"CDM"},{"code":"61314070101","type":"NDC"}],"standard_charges":[{"gross_charge":184.9,"discounted_cash":138.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEGFILGRASTIM-BMEZ SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx61314086601","type":"CDM"},{"code":"Q5120","type":"HCPCS"},{"code":"61314086601","type":"NDC"}],"standard_charges":[{"gross_charge":16517.21,"discounted_cash":12387.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442045101","type":"CDM"},{"code":"61442045101","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61553032872","type":"CDM"},{"code":"61553032872","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 200 MG/10ML (20 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61553036472","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"61553036472","type":"NDC"}],"standard_charges":[{"gross_charge":299.28,"discounted_cash":224.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx61570013150","type":"CDM"},{"code":"61570013150","type":"NDC"}],"standard_charges":[{"gross_charge":36.42,"discounted_cash":27.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx61703026205","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703026205","type":"NDC"}],"standard_charges":[{"gross_charge":135.64,"discounted_cash":101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYTARABINE INJ PF 20 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703030538","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61703030916","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"61703030916","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61703030925","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"61703030925","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703033918","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033918","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 150 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61703033922","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033922","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx61703033950","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033950","type":"NDC"}],"standard_charges":[{"gross_charge":135.64,"discounted_cash":101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 600 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx61703033956","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033956","type":"NDC"}],"standard_charges":[{"gross_charge":415.56,"discounted_cash":311.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VINORELBINE TARTRATE INJ 10 MG/ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx61703034106","type":"CDM"},{"code":"J9390","type":"HCPCS"},{"code":"61703034106","type":"NDC"}],"standard_charges":[{"gross_charge":189.67,"discounted_cash":142.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx61703034250","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":425.68,"discounted_cash":319.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703036018","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703036018","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61703036318","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"61703036318","type":"NDC"}],"standard_charges":[{"gross_charge":319.07,"discounted_cash":239.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx61703036322","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"61703036322","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 600 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx61703060005","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703060005","type":"NDC"}],"standard_charges":[{"gross_charge":193.74,"discounted_cash":145.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx61953000404","type":"CDM"},{"code":"J1572","type":"HCPCS"},{"code":"61953000404","type":"NDC"}],"standard_charges":[{"gross_charge":3856.51,"discounted_cash":2892.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GM/400ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx61953000405","type":"CDM"},{"code":"J1572","type":"HCPCS"},{"code":"61953000405","type":"NDC"}],"standard_charges":[{"gross_charge":7713.02,"discounted_cash":5784.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx61953000501","type":"CDM"},{"code":"J1572","type":"HCPCS"},{"code":"61953000501","type":"NDC"}],"standard_charges":[{"gross_charge":2795.01,"discounted_cash":2096.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx61953000502","type":"CDM"},{"code":"J1572","type":"HCPCS"},{"code":"61953000502","type":"NDC"}],"standard_charges":[{"gross_charge":3856.94,"discounted_cash":2892.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx61953000503","type":"CDM"},{"code":"J1572","type":"HCPCS"},{"code":"61953000503","type":"NDC"}],"standard_charges":[{"gross_charge":7713.89,"discounted_cash":5785.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EMTRICITABINE CAPS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958060101","type":"CDM"},{"code":"61958060101","type":"NDC"}],"standard_charges":[{"gross_charge":73.74,"discounted_cash":55.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"REMDESIVIR FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958290102","type":"CDM"},{"code":"J0248","type":"HCPCS"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"gross_charge":2827.83,"discounted_cash":2120.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx61990012001","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"61990012001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx61990012002","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"61990012002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx61990041100","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"61990041100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx61990041102","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"61990041102","type":"NDC"}],"standard_charges":[{"gross_charge":295.6,"discounted_cash":221.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62037059790","type":"CDM"},{"code":"62037059790","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62175011937","type":"CDM"},{"code":"62175011937","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62175012837","type":"CDM"},{"code":"62175012837","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACOSAMIDE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332017460","type":"CDM"},{"code":"62332017460","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332041510","type":"CDM"},{"code":"62332041510","type":"NDC"}],"standard_charges":[{"gross_charge":32.97,"discounted_cash":24.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx62332058204","type":"CDM"},{"code":"62332058204","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"UREA PACKET 15 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62530000011","type":"CDM"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559042401","type":"CDM"},{"code":"62559042401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559051101","type":"CDM"},{"code":"62559051101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559053001","type":"CDM"},{"code":"62559053001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559072201","type":"CDM"},{"code":"62559072201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026501","type":"CDM"},{"code":"62584026501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026511","type":"CDM"},{"code":"62584026511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584071301","type":"CDM"},{"code":"62584071301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584071311","type":"CDM"},{"code":"62584071311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584074701","type":"CDM"},{"code":"62584074701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584074711","type":"CDM"},{"code":"62584074711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584098411","type":"CDM"},{"code":"62584098411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584099401","type":"CDM"},{"code":"62584099401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584099411","type":"CDM"},{"code":"62584099411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR DELAYED RELEASE SUSP PACKET 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756007160","type":"CDM"},{"code":"62756007160","type":"NDC"}],"standard_charges":[{"gross_charge":42.8,"discounted_cash":32.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR DELAYED RELEASE SUSP PACKET 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756007164","type":"CDM"},{"code":"62756007164","type":"NDC"}],"standard_charges":[{"gross_charge":58.35,"discounted_cash":43.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756012940","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"62756012940","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756012944","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"62756012944","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756024060","type":"CDM"},{"code":"62756024060","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756024064","type":"CDM"},{"code":"62756024064","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051244","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"62756051244","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051788","type":"CDM"},{"code":"62756051788","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756079688","type":"CDM"},{"code":"62756079688","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756079888","type":"CDM"},{"code":"62756079888","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR SUBCUTANEOUS INJ KIT 22.5MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935022305","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935022305","type":"NDC"}],"standard_charges":[{"gross_charge":2152.12,"discounted_cash":1614.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR SUBCUTANEOUS INJ KIT 22.5MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935022710","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935022710","type":"NDC"}],"standard_charges":[{"gross_charge":2152.12,"discounted_cash":1614.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) FOR SUBCUTANEOUS INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935030330","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935030330","type":"NDC"}],"standard_charges":[{"gross_charge":2869.5,"discounted_cash":2152.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) FOR SUBCUTANEOUS INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935030640","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935030640","type":"NDC"}],"standard_charges":[{"gross_charge":2869.5,"discounted_cash":2152.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) FOR SUBCUTANEOUS INJ KIT 45 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935046150","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935046150","type":"NDC"}],"standard_charges":[{"gross_charge":4012.43,"discounted_cash":3009.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR SUBCUTANEOUS INJ KIT 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935075375","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935075375","type":"NDC"}],"standard_charges":[{"gross_charge":717.37,"discounted_cash":538.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR SUBCUTANEOUS INJ KIT 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935075680","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935075680","type":"NDC"}],"standard_charges":[{"gross_charge":717.37,"discounted_cash":538.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63020004901","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"63020004901","type":"NDC"}],"standard_charges":[{"gross_charge":11404.17,"discounted_cash":8553.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304009711","type":"CDM"},{"code":"63304009711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304009719","type":"CDM"},{"code":"63304009719","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323001002","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323001003","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001003","type":"NDC"}],"standard_charges":[{"gross_charge":146.74,"discounted_cash":110.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323001020","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":167.56,"discounted_cash":125.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001203","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001203","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001207","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001207","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001210","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001211","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001211","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001217","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001217","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001230","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001230","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001302","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001309","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001309","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323004401","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006401","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006403","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006404","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006404","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006411","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006421","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006421","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006423","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006423","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323008305","type":"CDM"},{"code":"63323008305","type":"NDC"}],"standard_charges":[{"gross_charge":158.07,"discounted_cash":118.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx63323008950","type":"CDM"},{"code":"63323008950","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323009301","type":"CDM"},{"code":"63323009301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323009330","type":"CDM"},{"code":"63323009330","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010351","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010351","type":"NDC"}],"standard_charges":[{"gross_charge":120.41,"discounted_cash":90.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CISPLATIN INJ 200 MG/200ML (1 MG/ML)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx63323010364","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010364","type":"NDC"}],"standard_charges":[{"gross_charge":481.67,"discounted_cash":361.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010365","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"gross_charge":240.83,"discounted_cash":180.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx63323010425","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"gross_charge":142.85,"discounted_cash":107.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010600","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010601","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010602","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010605","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323010615","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010615","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323011301","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"63323011301","type":"NDC"}],"standard_charges":[{"gross_charge":329.46,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323011310","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"63323011310","type":"NDC"}],"standard_charges":[{"gross_charge":329.14,"discounted_cash":246.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011710","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011719","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011719","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 1 GM/20ML (50 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323011720","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011731","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011731","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323011751","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011751","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323011759","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011759","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323011761","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"gross_charge":123.48,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323011769","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011769","type":"NDC"}],"standard_charges":[{"gross_charge":123.48,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323012553","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"63323012553","type":"NDC"}],"standard_charges":[{"gross_charge":345.53,"discounted_cash":259.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013002","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013002","type":"NDC"}],"standard_charges":[{"gross_charge":136.96,"discounted_cash":102.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013003","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013003","type":"NDC"}],"standard_charges":[{"gross_charge":112.1,"discounted_cash":84.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013011","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013011","type":"NDC"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":83.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013013","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013013","type":"NDC"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":83.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013017","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013017","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013041","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013041","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLADRIBINE IV SOLN 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323014010","type":"CDM"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010","type":"NDC"}],"standard_charges":[{"gross_charge":759.25,"discounted_cash":569.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323016100","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323016101","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323016112","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016112","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016200","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016200","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016201","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016202","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016203","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016203","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016212","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016212","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016214","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016214","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016225","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323016501","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323016502","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323016502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 600 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx63323017260","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"63323017260","type":"NDC"}],"standard_charges":[{"gross_charge":354.35,"discounted_cash":265.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323017301","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323017301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323017302","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323017395","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323017395","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323017876","type":"CDM"},{"code":"63323017876","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PYRIDOXINE HCL INJ 100 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323018000","type":"CDM"},{"code":"J3415","type":"HCPCS"},{"code":"63323018000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PYRIDOXINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323018001","type":"CDM"},{"code":"J3415","type":"HCPCS"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323018410","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323018507","type":"CDM"},{"code":"63323018507","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323018510","type":"CDM"},{"code":"63323018510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018601","type":"CDM"},{"code":"63323018601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018610","type":"CDM"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018620","type":"CDM"},{"code":"63323018620","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323019355","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"63323019355","type":"NDC"}],"standard_charges":[{"gross_charge":239.07,"discounted_cash":179.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020110","type":"CDM"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020805","type":"CDM"},{"code":"63323020805","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022905","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022915","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022915","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022921","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022921","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022930","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323023701","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"63323023701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323023710","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"63323023710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MINERAL OIL LIGHT (BULK)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323025410","type":"CDM"},{"code":"63323025410","type":"NDC"}],"standard_charges":[{"gross_charge":21.38,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323026037","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323026037","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROGESTERONE IM IN OIL 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323026110","type":"CDM"},{"code":"J2675","type":"HCPCS"},{"code":"63323026110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026203","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026203","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026206","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026206","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026209","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026209","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026211","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026211","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026226","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026226","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323026530","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"63323026530","type":"NDC"}],"standard_charges":[{"gross_charge":229.86,"discounted_cash":172.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":20.0,"type":"ML"},"code_information":[{"code":"Rx63323026929","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":2.0,"type":"ML"},"code_information":[{"code":"Rx63323026929","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323026937","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026937","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323026950","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx63323026957","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026957","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323026965","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx63323026967","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026967","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VINBLASTINE SULFATE INJ 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323027810","type":"CDM"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":374.06,"discounted_cash":280.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323028420","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028513","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028513","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028520","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028605","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028605","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028609","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028609","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028611","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028611","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028623","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028623","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028635","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028635","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028693","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028693","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":1.33333333333333,"type":"ML"},"code_information":[{"code":"Rx63323029301","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":1.33333333333333,"type":"ML"},"code_information":[{"code":"Rx63323029337","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029337","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323031110","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323031110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036001","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036019","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323037600","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323037601","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323037805","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037805","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFOTETAN DISODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323038510","type":"CDM"},{"code":"J0525","type":"HCPCS"},{"code":"63323038510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFOTETAN DISODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323038620","type":"CDM"},{"code":"J0525","type":"HCPCS"},{"code":"63323038620","type":"NDC"}],"standard_charges":[{"gross_charge":135.92,"discounted_cash":101.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039801","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"63323039801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039810","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039812","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"63323039812","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040101","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040101","type":"NDC"}],"standard_charges":[{"gross_charge":183.05,"discounted_cash":137.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040120","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"gross_charge":148.27,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040126","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040126","type":"NDC"}],"standard_charges":[{"gross_charge":148.27,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040220","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"gross_charge":302.8,"discounted_cash":227.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040230","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040230","type":"NDC"}],"standard_charges":[{"gross_charge":302.8,"discounted_cash":227.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323040302","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323040304","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040304","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323040310","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323042405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323042405","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323045100","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045100","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323045101","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046201","type":"CDM"},{"code":"63323046201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046204","type":"CDM"},{"code":"63323046204","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046217","type":"CDM"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046237","type":"CDM"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046417","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046757","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046802","type":"CDM"},{"code":"63323046802","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046837","type":"CDM"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323047400","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"63323047400","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323047401","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047801","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"63323047801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047827","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"63323047827","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 0.5% W/ EPINEPHRINE-1:200000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048157","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048157","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048203","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048203","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048205","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048205","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048226","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048226","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048227","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048257","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048257","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048303","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048303","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048327","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048527","type":"CDM"},{"code":"63323048527","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048627","type":"CDM"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048707","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048707","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048737","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048737","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323048889","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048889","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048921","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048921","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048927","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323049101","type":"CDM"},{"code":"63323049101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323049157","type":"CDM"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049207","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049207","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049209","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049209","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049257","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049301","type":"CDM"},{"code":"63323049301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049391","type":"CDM"},{"code":"63323049391","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049504","type":"CDM"},{"code":"63323049504","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049507","type":"CDM"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323050601","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050719","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050719","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050720","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050721","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050721","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050801","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050830","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050831","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050831","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051701","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051701","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051774","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051774","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323053021","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"63323053021","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx63323053101","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323053501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323053508","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053508","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323053587","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053587","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323053598","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053598","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054003","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054003","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054005","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054007","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054007","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054013","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054013","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054015","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054015","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055963","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055963","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055965","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055965","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055993","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055993","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056463","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056463","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056465","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056465","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056497","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056497","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056663","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056663","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056665","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056665","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056698","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056698","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323056883","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056883","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058621","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058621","type":"NDC"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":90.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058663","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058663","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058665","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058665","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058696","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058696","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx63323058921","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058921","type":"NDC"}],"standard_charges":[{"gross_charge":175.01,"discounted_cash":131.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx63323058994","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058994","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059303","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059303","type":"NDC"}],"standard_charges":[{"gross_charge":715.98,"discounted_cash":536.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059403","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059403","type":"NDC"}],"standard_charges":[{"gross_charge":715.73,"discounted_cash":536.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323060400","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"63323060400","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323060401","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"63323060401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323060501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323060501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323060584","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323060584","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323060701","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323060701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323061400","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061400","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061401","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061455","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061455","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323061603","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323061720","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"63323061720","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064907","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323064907","type":"NDC"}],"standard_charges":[{"gross_charge":487.78,"discounted_cash":365.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064916","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"63323064916","type":"NDC"}],"standard_charges":[{"gross_charge":487.78,"discounted_cash":365.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323065210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"gross_charge":120.65,"discounted_cash":90.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx63323065521","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323065521","type":"NDC"}],"standard_charges":[{"gross_charge":148.1,"discounted_cash":111.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx63323065599","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323065599","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323065820","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"63323065820","type":"NDC"}],"standard_charges":[{"gross_charge":285.57,"discounted_cash":214.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323065827","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"63323065827","type":"NDC"}],"standard_charges":[{"gross_charge":327.35,"discounted_cash":245.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx63323066005","type":"CDM"},{"code":"63323066005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066401","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066501","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323069030","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323071100","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"63323071100","type":"NDC"}],"standard_charges":[{"gross_charge":316.31,"discounted_cash":237.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx63323071303","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"63323071303","type":"NDC"}],"standard_charges":[{"gross_charge":220.73,"discounted_cash":165.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx63323071313","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"63323071313","type":"NDC"}],"standard_charges":[{"gross_charge":108.66,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072801","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"63323072801","type":"NDC"}],"standard_charges":[{"gross_charge":183.37,"discounted_cash":137.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072810","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"63323072810","type":"NDC"}],"standard_charges":[{"gross_charge":117.91,"discounted_cash":88.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323073912","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323075100","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"63323075100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323075101","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"63323075101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323076350","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"63323076350","type":"NDC"}],"standard_charges":[{"gross_charge":908.89,"discounted_cash":681.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323078141","type":"CDM"},{"code":"63323078141","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323078144","type":"CDM"},{"code":"63323078144","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx63323088116","type":"CDM"},{"code":"63323088116","type":"NDC"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":117.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323092401","type":"CDM"},{"code":"63323092401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323092410","type":"CDM"},{"code":"63323092410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323093001","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323096502","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323096503","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096503","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323096510","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323096520","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323096600","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"63323096600","type":"NDC"}],"standard_charges":[{"gross_charge":486.73,"discounted_cash":365.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323097002","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"63323097002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPH-TET TOX-AC PERT AD-POLIO IPV-HIB-HEP B REC SUSP PRE SYR","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63361024315","type":"CDM"},{"code":"90697","type":"HCPCS"},{"code":"63361024315","type":"NDC"}],"standard_charges":[{"gross_charge":622.51,"discounted_cash":466.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPH-TET TOX-AC PERT AD-POLIO IPV-HIB-HEP B REC SUSP PRE SYR","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63361024388","type":"CDM"},{"code":"90697","type":"HCPCS"},{"code":"63361024388","type":"NDC"}],"standard_charges":[{"gross_charge":726.38,"discounted_cash":544.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 100 MG/10ML (10 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63459010310","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":3991.2,"discounted_cash":2993.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63459010450","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":18009.77,"discounted_cash":13507.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENDAMUSTINE HCL IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx63459034804","type":"CDM"},{"code":"J9034","type":"HCPCS"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":14266.96,"discounted_cash":10700.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENDAMUSTINE HCL FOR IV SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63459039008","type":"CDM"},{"code":"J9033","type":"HCPCS"},{"code":"63459039008","type":"NDC"}],"standard_charges":[{"gross_charge":3697.32,"discounted_cash":2772.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENDAMUSTINE HCL FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63459039120","type":"CDM"},{"code":"J9033","type":"HCPCS"},{"code":"63459039120","type":"NDC"}],"standard_charges":[{"gross_charge":15690.38,"discounted_cash":11767.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx63459091211","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":1276.12,"discounted_cash":957.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx63459091215","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091215","type":"NDC"}],"standard_charges":[{"gross_charge":1276.09,"discounted_cash":957.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZOCAINE RECTAL OINTMENT 20%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx63736003751","type":"CDM"},{"code":"63736003751","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PERMETHRIN CREME RINSE 1%","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx63736012002","type":"CDM"},{"code":"63736012002","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":8.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739000532","type":"CDM"},{"code":"63739000532","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739005110","type":"CDM"},{"code":"63739005110","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739005910","type":"CDM"},{"code":"63739005910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739007310","type":"CDM"},{"code":"63739007310","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739008610","type":"CDM"},{"code":"63739008610","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739012810","type":"CDM"},{"code":"63739012810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739014510","type":"CDM"},{"code":"63739014510","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739016510","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"63739016510","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739016610","type":"CDM"},{"code":"63739016610","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63739019601","type":"CDM"},{"code":"63739019601","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63739019610","type":"CDM"},{"code":"63739019610","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739021202","type":"CDM"},{"code":"63739021202","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739022510","type":"CDM"},{"code":"63739022510","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026310","type":"CDM"},{"code":"63739026310","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026910","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"63739026910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739032601","type":"CDM"},{"code":"63739032601","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739032710","type":"CDM"},{"code":"63739032710","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739040310","type":"CDM"},{"code":"63739040310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739043402","type":"CDM"},{"code":"63739043402","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739044310","type":"CDM"},{"code":"63739044310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739048310","type":"CDM"},{"code":"63739048310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739051910","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"63739051910","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739052010","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"63739052010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739054410","type":"CDM"},{"code":"63739054410","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739056710","type":"CDM"},{"code":"63739056710","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739064510","type":"CDM"},{"code":"63739064510","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739069310","type":"CDM"},{"code":"63739069310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739090210","type":"CDM"},{"code":"63739090210","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739090310","type":"CDM"},{"code":"63739090310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63739093114","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63739093114","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63739093128","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63739093128","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739094310","type":"CDM"},{"code":"63739094310","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63739095311","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63739095311","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63739095325","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63739095325","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739098410","type":"CDM"},{"code":"63739098410","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63824000815","type":"CDM"},{"code":"63824000815","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500-1200 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061602","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061602","type":"NDC"}],"standard_charges":[{"gross_charge":4437.3,"discounted_cash":3327.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1000-2400 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061702","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061702","type":"NDC"}],"standard_charges":[{"gross_charge":8201.09,"discounted_cash":6150.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx64253040030","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"64253040030","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx64253040091","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"64253040091","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253090030","type":"CDM"},{"code":"64253090030","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253090091","type":"CDM"},{"code":"64253090091","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380015801","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"64380015801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64380016001","type":"CDM"},{"code":"64380016001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380073706","type":"CDM"},{"code":"64380073706","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380079701","type":"CDM"},{"code":"64380079701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NATALIZUMAB FOR IV INJ CONC 300 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx64406000801","type":"CDM"},{"code":"J2323","type":"HCPCS"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"gross_charge":15185.47,"discounted_cash":11389.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx64679005601","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx64679005602","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"64679005602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679042201","type":"CDM"},{"code":"64679042201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx64679046551","type":"CDM"},{"code":"64679046551","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679070301","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"64679070301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679070302","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"64679070302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx64679072801","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"64679072801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx64679072808","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"64679072808","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx64679075912","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"64679075912","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENALAPRIL MALEATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679092402","type":"CDM"},{"code":"64679092402","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764015104","type":"CDM"},{"code":"64764015104","type":"NDC"}],"standard_charges":[{"gross_charge":54.27,"discounted_cash":40.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VEDOLIZUMAB FOR IV SOLUTION 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764030020","type":"CDM"},{"code":"J3380","type":"HCPCS"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":40675.1,"discounted_cash":30506.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 45 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764045124","type":"CDM"},{"code":"64764045124","type":"NDC"}],"standard_charges":[{"gross_charge":89.88,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COCAINE HCL NASAL SOLN 40 MG/ML (4%)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx64950036204","type":"CDM"},{"code":"C9046","type":"HCPCS"},{"code":"64950036204","type":"NDC"}],"standard_charges":[{"gross_charge":1664.88,"discounted_cash":1248.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POT PHOS MONOBASIC W/SOD PHOS DI & MONOBAS TAB 155-852-130MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980010401","type":"CDM"},{"code":"64980010401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx64980030130","type":"CDM"},{"code":"64980030130","type":"NDC"}],"standard_charges":[{"gross_charge":199.41,"discounted_cash":149.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx64980032005","type":"CDM"},{"code":"64980032005","type":"NDC"}],"standard_charges":[{"gross_charge":113.06,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx64980032430","type":"CDM"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":37.91,"discounted_cash":28.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980033901","type":"CDM"},{"code":"64980033901","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980033902","type":"CDM"},{"code":"64980033902","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMCICLOVIR TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980035103","type":"CDM"},{"code":"64980035103","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64980051405","type":"CDM"},{"code":"64980051405","type":"NDC"}],"standard_charges":[{"gross_charge":40.56,"discounted_cash":30.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64980051505","type":"CDM"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"gross_charge":62.73,"discounted_cash":47.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162014904","type":"CDM"},{"code":"65162014904","type":"NDC"}],"standard_charges":[{"gross_charge":33.73,"discounted_cash":25.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162014908","type":"CDM"},{"code":"65162014908","type":"NDC"}],"standard_charges":[{"gross_charge":36.04,"discounted_cash":27.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162047810","type":"CDM"},{"code":"65162047810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SALSALATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162051210","type":"CDM"},{"code":"65162051210","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162057210","type":"CDM"},{"code":"65162057210","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162059606","type":"CDM"},{"code":"65162059606","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE SOLN 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65162067384","type":"CDM"},{"code":"65162067384","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162068210","type":"CDM"},{"code":"65162068210","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65162069179","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"65162069179","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162077810","type":"CDM"},{"code":"65162077810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx65162083594","type":"CDM"},{"code":"65162083594","type":"NDC"}],"standard_charges":[{"gross_charge":51.67,"discounted_cash":38.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089703","type":"CDM"},{"code":"65162089703","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089803","type":"CDM"},{"code":"65162089803","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162099304","type":"CDM"},{"code":"65162099304","type":"NDC"}],"standard_charges":[{"gross_charge":32.48,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162099308","type":"CDM"},{"code":"65162099308","type":"NDC"}],"standard_charges":[{"gross_charge":39.63,"discounted_cash":29.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162099704","type":"CDM"},{"code":"65162099704","type":"NDC"}],"standard_charges":[{"gross_charge":31.04,"discounted_cash":23.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162099708","type":"CDM"},{"code":"65162099708","type":"NDC"}],"standard_charges":[{"gross_charge":36.58,"discounted_cash":27.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx65219011801","type":"CDM"},{"code":"65219011801","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx65219014808","type":"CDM"},{"code":"65219014808","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx65219014810","type":"CDM"},{"code":"65219014810","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx65219028100","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"65219028100","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx65219028102","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"65219028102","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219029300","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"65219029300","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219029301","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"65219029301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx65219046805","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"65219046805","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx65219046850","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"65219046850","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx65219053325","type":"CDM"},{"code":"65219053325","type":"NDC"}],"standard_charges":[{"gross_charge":175.45,"discounted_cash":131.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx65219062404","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"65219062404","type":"NDC"}],"standard_charges":[{"gross_charge":192.63,"discounted_cash":144.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx65219062420","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"65219062420","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAM-TRASTUZUMAB DERUXTECAN-NXKI FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65597040601","type":"CDM"},{"code":"J9358","type":"HCPCS"},{"code":"65597040601","type":"NDC"}],"standard_charges":[{"gross_charge":21957.93,"discounted_cash":16468.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx65628001605","type":"CDM"},{"code":"65628001605","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":119.0,"type":"ML"},"code_information":[{"code":"Rx65628005004","type":"CDM"},{"code":"65628005004","type":"NDC"}],"standard_charges":[{"gross_charge":370.87,"discounted_cash":278.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LANSOPRAZOLE SUSP 3 MG/ML (COMPOUND KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628008005","type":"CDM"},{"code":"65628008005","type":"NDC"}],"standard_charges":[{"gross_charge":24.03,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx65628020605","type":"CDM"},{"code":"65628020605","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIFAXIMIN TAB 550 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030302","type":"CDM"},{"code":"65649030302","type":"NDC"}],"standard_charges":[{"gross_charge":237.93,"discounted_cash":178.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIFAXIMIN TAB 550 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030303","type":"CDM"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":237.93,"discounted_cash":178.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),METHYLNALTREXONE BROMIDE SOLN PREF SYR 12 MG/0.6ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx65649055107","type":"CDM"},{"code":"J2212","type":"HCPCS"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"gross_charge":657.26,"discounted_cash":492.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862001601","type":"CDM"},{"code":"65862001601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862001701","type":"CDM"},{"code":"65862001701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZIDOVUDINE SYRUP 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862004824","type":"CDM"},{"code":"65862004824","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862007601","type":"CDM"},{"code":"65862007601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014636","type":"CDM"},{"code":"65862014636","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014930","type":"CDM"},{"code":"65862014930","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014990","type":"CDM"},{"code":"65862014990","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017501","type":"CDM"},{"code":"65862017501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017760","type":"CDM"},{"code":"65862017760","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862019201","type":"CDM"},{"code":"65862019201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862019301","type":"CDM"},{"code":"65862019301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020290","type":"CDM"},{"code":"65862020290","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx65862021901","type":"CDM"},{"code":"65862021901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862023060","type":"CDM"},{"code":"65862023060","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862029490","type":"CDM"},{"code":"65862029490","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862039010","type":"CDM"},{"code":"65862039010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862049647","type":"CDM"},{"code":"65862049647","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050220","type":"CDM"},{"code":"65862050220","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052790","type":"CDM"},{"code":"65862052790","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052890","type":"CDM"},{"code":"65862052890","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862059801","type":"CDM"},{"code":"65862059801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862064960","type":"CDM"},{"code":"65862064960","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067601","type":"CDM"},{"code":"65862067601","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067701","type":"CDM"},{"code":"65862067701","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862069960","type":"CDM"},{"code":"65862069960","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862070020","type":"CDM"},{"code":"65862070020","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx65862084003","type":"CDM"},{"code":"65862084003","type":"NDC"}],"standard_charges":[{"gross_charge":138.02,"discounted_cash":103.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx66220020730","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"66220020730","type":"NDC"}],"standard_charges":[{"gross_charge":167.12,"discounted_cash":125.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66553000201","type":"CDM"},{"code":"66553000201","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66553000401","type":"CDM"},{"code":"66553000401","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100100","type":"CDM"},{"code":"66685100100","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100200","type":"CDM"},{"code":"66685100200","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002301","type":"CDM"},{"code":"66689002301","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002304","type":"CDM"},{"code":"66689002304","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002350","type":"CDM"},{"code":"66689002350","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003101","type":"CDM"},{"code":"66689003101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003150","type":"CDM"},{"code":"66689003150","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx66689003601","type":"CDM"},{"code":"66689003601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx66689003650","type":"CDM"},{"code":"66689003650","type":"NDC"}],"standard_charges":[{"gross_charge":25.36,"discounted_cash":19.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003701","type":"CDM"},{"code":"66689003701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003799","type":"CDM"},{"code":"66689003799","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66689004701","type":"CDM"},{"code":"66689004701","type":"NDC"}],"standard_charges":[{"gross_charge":16.35,"discounted_cash":12.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66689004750","type":"CDM"},{"code":"66689004750","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx66689020204","type":"CDM"},{"code":"66689020204","type":"NDC"}],"standard_charges":[{"gross_charge":20.3,"discounted_cash":15.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CETUXIMAB IV SOLN 100 MG/50ML (2 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx66733094823","type":"CDM"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":5484.05,"discounted_cash":4113.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CETUXIMAB IV SOLN 200 MG/100ML (2 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx66733095823","type":"CDM"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":10968.1,"discounted_cash":8226.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 20 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66758005001","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"66758005001","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 80 MG/8ML","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx66758005002","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"66758005002","type":"NDC"}],"standard_charges":[{"gross_charge":235.62,"discounted_cash":176.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx66758005003","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"66758005003","type":"NDC"}],"standard_charges":[{"gross_charge":492.22,"discounted_cash":369.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx66794021943","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx66794021963","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"66794021963","type":"NDC"}],"standard_charges":[{"gross_charge":336.18,"discounted_cash":252.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66794023302","type":"CDM"},{"code":"66794023302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66794023342","type":"CDM"},{"code":"66794023342","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx66993000210","type":"CDM"},{"code":"66993000210","type":"NDC"}],"standard_charges":[{"gross_charge":104.35,"discounted_cash":78.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":0.00018,"type":"GM"},"code_information":[{"code":"Rx66993001968","type":"CDM"},{"code":"66993001968","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993005702","type":"CDM"},{"code":"66993005702","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993006851","type":"CDM"},{"code":"66993006851","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993006880","type":"CDM"},{"code":"66993006880","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx66993019020","type":"CDM"},{"code":"66993019020","type":"NDC"}],"standard_charges":[{"gross_charge":394.9,"discounted_cash":296.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASCORBIC ACID IV SOLN 25000 MG/50ML (500 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx67157010150","type":"CDM"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"gross_charge":1570.15,"discounted_cash":1177.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67253032036","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"67253032036","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPTINEZUMAB-JJMR IV SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67386013051","type":"CDM"},{"code":"J3032","type":"HCPCS"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":8430.91,"discounted_cash":6323.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASCORBIC ACID INJ 500 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457011850","type":"CDM"},{"code":"67457011850","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015300","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015300","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015303","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMIODARONE HCL INJ 900 MG/18ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015318","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015318","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIMETHYL SULFOXIDE SOLN 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx67457017750","type":"CDM"},{"code":"J1212","type":"HCPCS"},{"code":"67457017750","type":"NDC"}],"standard_charges":[{"gross_charge":2922.3,"discounted_cash":2191.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018200","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018200","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457019600","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"67457019600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457019602","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"67457019602","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457019700","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"67457019700","type":"NDC"}],"standard_charges":[{"gross_charge":101.88,"discounted_cash":76.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457019710","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"67457019710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457019800","type":"CDM"},{"code":"67457019800","type":"NDC"}],"standard_charges":[{"gross_charge":331.85,"discounted_cash":248.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457019803","type":"CDM"},{"code":"67457019803","type":"NDC"}],"standard_charges":[{"gross_charge":331.85,"discounted_cash":248.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457021810","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457022000","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022000","type":"NDC"}],"standard_charges":[{"gross_charge":1828.74,"discounted_cash":1371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457022005","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":1828.14,"discounted_cash":1371.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457022702","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"67457022702","type":"NDC"}],"standard_charges":[{"gross_charge":511.95,"discounted_cash":383.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457025100","type":"CDM"},{"code":"67457025100","type":"NDC"}],"standard_charges":[{"gross_charge":114.4,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457025102","type":"CDM"},{"code":"67457025102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457025905","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"67457025905","type":"NDC"}],"standard_charges":[{"gross_charge":2113.44,"discounted_cash":1585.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029200","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029200","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029202","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457031725","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"67457031725","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457033950","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457033950","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034000","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457034000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034001","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034810","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"67457034810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034910","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"67457034910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457035202","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"67457035202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457035210","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"67457035210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx67457037412","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"67457037412","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx67457037499","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"67457037499","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457041900","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457041900","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457041901","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457041901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 100 MG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042000","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 100 MG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042010","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 20 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042200","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042200","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 20 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042254","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042254","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042300","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042300","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042312","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042600","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042612","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457043300","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457043300","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457043322","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043800","type":"CDM"},{"code":"67457043800","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043810","type":"CDM"},{"code":"67457043810","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 9 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457044610","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"67457044610","type":"NDC"}],"standard_charges":[{"gross_charge":188.52,"discounted_cash":141.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457051600","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"67457051600","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457051625","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"67457051625","type":"NDC"}],"standard_charges":[{"gross_charge":101.91,"discounted_cash":76.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457051700","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"67457051700","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457051701","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"67457051701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBANDRONATE SODIUM IV SOLN 3 MG/3ML (BASE EQUIVALENT)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457052433","type":"CDM"},{"code":"J1740","type":"HCPCS"},{"code":"67457052433","type":"NDC"}],"standard_charges":[{"gross_charge":1421.53,"discounted_cash":1066.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457052810","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"67457052810","type":"NDC"}],"standard_charges":[{"gross_charge":140.51,"discounted_cash":105.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457053035","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"gross_charge":133.15,"discounted_cash":99.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx67457053316","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"67457053316","type":"NDC"}],"standard_charges":[{"gross_charge":547.69,"discounted_cash":410.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx67457055400","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"67457055400","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457058200","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058200","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457058210","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457061100","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457061100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457061110","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457061110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 2 GM/52.6ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":52.6,"type":"ML"},"code_information":[{"code":"Rx67457061810","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"67457061810","type":"NDC"}],"standard_charges":[{"gross_charge":190.02,"discounted_cash":142.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx67457061910","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"67457061910","type":"NDC"}],"standard_charges":[{"gross_charge":674.64,"discounted_cash":505.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457063900","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"67457063900","type":"NDC"}],"standard_charges":[{"gross_charge":107.53,"discounted_cash":80.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457063910","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"67457063910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457064000","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"67457064000","type":"NDC"}],"standard_charges":[{"gross_charge":125.69,"discounted_cash":94.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457064099","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"67457064099","type":"NDC"}],"standard_charges":[{"gross_charge":124.3,"discounted_cash":93.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457064502","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457064502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCITONIN (SALMON) INJ 200 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457067502","type":"CDM"},{"code":"J0630","type":"HCPCS"},{"code":"67457067502","type":"NDC"}],"standard_charges":[{"gross_charge":2815.52,"discounted_cash":2111.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":8.0,"type":"ML"},"code_information":[{"code":"Rx67457078108","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"67457078108","type":"NDC"}],"standard_charges":[{"gross_charge":255.56,"discounted_cash":191.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457079000","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"67457079000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457079005","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"67457079005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082312","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"gross_charge":136.56,"discounted_cash":102.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082399","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"gross_charge":131.01,"discounted_cash":98.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082415","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082415","type":"NDC"}],"standard_charges":[{"gross_charge":163.87,"discounted_cash":122.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082499","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082499","type":"NDC"}],"standard_charges":[{"gross_charge":162.03,"discounted_cash":121.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457085350","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"67457085350","type":"NDC"}],"standard_charges":[{"gross_charge":268.64,"discounted_cash":201.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085500","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085500","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085502","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457086000","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"67457086000","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457086050","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"67457086050","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GRANISETRON HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457086301","type":"CDM"},{"code":"J1626","type":"HCPCS"},{"code":"67457086301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67618010110","type":"CDM"},{"code":"67618010110","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx67618020004","type":"CDM"},{"code":"67618020004","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx67618020008","type":"CDM"},{"code":"67618020008","type":"NDC"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":946.0,"type":"ML"},"code_information":[{"code":"Rx67618020030","type":"CDM"},{"code":"67618020030","type":"NDC"}],"standard_charges":[{"gross_charge":15.63,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877012405","type":"CDM"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"gross_charge":41.15,"discounted_cash":30.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877012450","type":"CDM"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":41.15,"discounted_cash":30.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877015901","type":"CDM"},{"code":"67877015901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022001","type":"CDM"},{"code":"67877022001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022201","type":"CDM"},{"code":"67877022201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022301","type":"CDM"},{"code":"67877022301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877025001","type":"CDM"},{"code":"67877025001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877025010","type":"CDM"},{"code":"67877025010","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx67877025115","type":"CDM"},{"code":"67877025115","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx67877025145","type":"CDM"},{"code":"67877025145","type":"NDC"}],"standard_charges":[{"gross_charge":91.87,"discounted_cash":68.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877031901","type":"CDM"},{"code":"67877031901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877032101","type":"CDM"},{"code":"67877032101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041390","type":"CDM"},{"code":"67877041390","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041920","type":"CDM"},{"code":"67877041920","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FINASTERIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877045590","type":"CDM"},{"code":"67877045590","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049030","type":"CDM"},{"code":"67877049030","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049160","type":"CDM"},{"code":"67877049160","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67877054568","type":"CDM"},{"code":"67877054568","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67877054588","type":"CDM"},{"code":"67877054588","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx67877054798","type":"CDM"},{"code":"67877054798","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx67877054888","type":"CDM"},{"code":"67877054888","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877057301","type":"CDM"},{"code":"67877057301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877073360","type":"CDM"},{"code":"67877073360","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877074957","type":"CDM"},{"code":"67877074957","type":"NDC"}],"standard_charges":[{"gross_charge":244.56,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67877075181","type":"CDM"},{"code":"67877075181","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877075360","type":"CDM"},{"code":"67877075360","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68047025301","type":"CDM"},{"code":"68047025301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002701","type":"CDM"},{"code":"68084002701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002711","type":"CDM"},{"code":"68084002711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002801","type":"CDM"},{"code":"68084002801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004401","type":"CDM"},{"code":"68084004401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007001","type":"CDM"},{"code":"68084007001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007011","type":"CDM"},{"code":"68084007011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009301","type":"CDM"},{"code":"68084009301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009311","type":"CDM"},{"code":"68084009311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009401","type":"CDM"},{"code":"68084009401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009411","type":"CDM"},{"code":"68084009411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009701","type":"CDM"},{"code":"68084009701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009711","type":"CDM"},{"code":"68084009711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009801","type":"CDM"},{"code":"68084009801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009811","type":"CDM"},{"code":"68084009811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009901","type":"CDM"},{"code":"68084009901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009911","type":"CDM"},{"code":"68084009911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084010801","type":"CDM"},{"code":"68084010801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084010811","type":"CDM"},{"code":"68084010811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019601","type":"CDM"},{"code":"68084019601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019611","type":"CDM"},{"code":"68084019611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021401","type":"CDM"},{"code":"68084021401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021411","type":"CDM"},{"code":"68084021411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023001","type":"CDM"},{"code":"68084023001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023011","type":"CDM"},{"code":"68084023011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024301","type":"CDM"},{"code":"68084024301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024311","type":"CDM"},{"code":"68084024311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024801","type":"CDM"},{"code":"68084024801","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025301","type":"CDM"},{"code":"68084025301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025311","type":"CDM"},{"code":"68084025311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027201","type":"CDM"},{"code":"68084027201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027211","type":"CDM"},{"code":"68084027211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028201","type":"CDM"},{"code":"68084028201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028211","type":"CDM"},{"code":"68084028211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028801","type":"CDM"},{"code":"68084028801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028811","type":"CDM"},{"code":"68084028811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALTREXONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029111","type":"CDM"},{"code":"68084029111","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALTREXONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029121","type":"CDM"},{"code":"68084029121","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029901","type":"CDM"},{"code":"68084029901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029911","type":"CDM"},{"code":"68084029911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031801","type":"CDM"},{"code":"68084031801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031811","type":"CDM"},{"code":"68084031811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032601","type":"CDM"},{"code":"68084032601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032611","type":"CDM"},{"code":"68084032611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032811","type":"CDM"},{"code":"68084032811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033701","type":"CDM"},{"code":"68084033701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033711","type":"CDM"},{"code":"68084033711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034201","type":"CDM"},{"code":"68084034201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034211","type":"CDM"},{"code":"68084034211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034401","type":"CDM"},{"code":"68084034401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034411","type":"CDM"},{"code":"68084034411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034701","type":"CDM"},{"code":"68084034701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034711","type":"CDM"},{"code":"68084034711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035401","type":"CDM"},{"code":"68084035401","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035411","type":"CDM"},{"code":"68084035411","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040001","type":"CDM"},{"code":"68084040001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040011","type":"CDM"},{"code":"68084040011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044701","type":"CDM"},{"code":"68084044701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044711","type":"CDM"},{"code":"68084044711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047701","type":"CDM"},{"code":"68084047701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048201","type":"CDM"},{"code":"68084048201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOFLOXACIN TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048311","type":"CDM"},{"code":"68084048311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049101","type":"CDM"},{"code":"68084049101","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049111","type":"CDM"},{"code":"68084049111","type":"NDC"}],"standard_charges":[{"gross_charge":0.93,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049701","type":"CDM"},{"code":"68084049701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049711","type":"CDM"},{"code":"68084049711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050201","type":"CDM"},{"code":"68084050201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050211","type":"CDM"},{"code":"68084050211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053901","type":"CDM"},{"code":"68084053901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053911","type":"CDM"},{"code":"68084053911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOVASTATIN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084055901","type":"CDM"},{"code":"68084055901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOVASTATIN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084055911","type":"CDM"},{"code":"68084055911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056401","type":"CDM"},{"code":"68084056401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084057211","type":"CDM"},{"code":"68084057211","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084058911","type":"CDM"},{"code":"68084058911","type":"NDC"}],"standard_charges":[{"gross_charge":13.44,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059411","type":"CDM"},{"code":"68084059411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060611","type":"CDM"},{"code":"68084060611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060621","type":"CDM"},{"code":"68084060621","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061701","type":"CDM"},{"code":"68084061701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061711","type":"CDM"},{"code":"68084061711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061801","type":"CDM"},{"code":"68084061801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061811","type":"CDM"},{"code":"68084061811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064001","type":"CDM"},{"code":"68084064001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064011","type":"CDM"},{"code":"68084064011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064501","type":"CDM"},{"code":"68084064501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064511","type":"CDM"},{"code":"68084064511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067601","type":"CDM"},{"code":"68084067601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067611","type":"CDM"},{"code":"68084067611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069801","type":"CDM"},{"code":"68084069801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069811","type":"CDM"},{"code":"68084069811","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070301","type":"CDM"},{"code":"68084070301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070311","type":"CDM"},{"code":"68084070311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070825","type":"CDM"},{"code":"68084070825","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070895","type":"CDM"},{"code":"68084070895","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070901","type":"CDM"},{"code":"68084070901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070911","type":"CDM"},{"code":"68084070911","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084072501","type":"CDM"},{"code":"68084072501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084072511","type":"CDM"},{"code":"68084072511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084073801","type":"CDM"},{"code":"68084073801","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084073811","type":"CDM"},{"code":"68084073811","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077401","type":"CDM"},{"code":"68084077401","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077411","type":"CDM"},{"code":"68084077411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078211","type":"CDM"},{"code":"68084078211","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078261","type":"CDM"},{"code":"68084078261","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078301","type":"CDM"},{"code":"68084078301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078311","type":"CDM"},{"code":"68084078311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080801","type":"CDM"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080811","type":"CDM"},{"code":"68084080811","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084081309","type":"CDM"},{"code":"68084081309","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084081311","type":"CDM"},{"code":"68084081311","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082725","type":"CDM"},{"code":"68084082725","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082795","type":"CDM"},{"code":"68084082795","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085125","type":"CDM"},{"code":"68084085125","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085195","type":"CDM"},{"code":"68084085195","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084086225","type":"CDM"},{"code":"68084086225","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084086295","type":"CDM"},{"code":"68084086295","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089509","type":"CDM"},{"code":"68084089509","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089511","type":"CDM"},{"code":"68084089511","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPYLTHIOURACIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096425","type":"CDM"},{"code":"68084096425","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROPYLTHIOURACIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096495","type":"CDM"},{"code":"68084096495","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084099601","type":"CDM"},{"code":"68084099601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084099611","type":"CDM"},{"code":"68084099611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094000159","type":"CDM"},{"code":"68094000159","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094000162","type":"CDM"},{"code":"68094000162","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001859","type":"CDM"},{"code":"68094001859","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001861","type":"CDM"},{"code":"68094001861","type":"NDC"}],"standard_charges":[{"gross_charge":0.7,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094002259","type":"CDM"},{"code":"68094002259","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094002262","type":"CDM"},{"code":"68094002262","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094004501","type":"CDM"},{"code":"68094004501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094004558","type":"CDM"},{"code":"68094004558","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094005601","type":"CDM"},{"code":"68094005601","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094005658","type":"CDM"},{"code":"68094005658","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094010120","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"68094010120","type":"NDC"}],"standard_charges":[{"gross_charge":1850.89,"discounted_cash":1388.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx68094012062","type":"CDM"},{"code":"68094012062","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094012062","type":"CDM"},{"code":"68094012062","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094013001","type":"CDM"},{"code":"68094013001","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094013058","type":"CDM"},{"code":"68094013058","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094019362","type":"CDM"},{"code":"68094019362","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094023162","type":"CDM"},{"code":"68094023162","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx68094033059","type":"CDM"},{"code":"68094033059","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx68094033061","type":"CDM"},{"code":"68094033061","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx68094033062","type":"CDM"},{"code":"68094033062","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094049459","type":"CDM"},{"code":"68094049459","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094049461","type":"CDM"},{"code":"68094049461","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094049462","type":"CDM"},{"code":"68094049462","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094050359","type":"CDM"},{"code":"68094050359","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094050362","type":"CDM"},{"code":"68094050362","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68094075659","type":"CDM"},{"code":"68094075659","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68094075662","type":"CDM"},{"code":"68094075662","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076459","type":"CDM"},{"code":"68094076459","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076462","type":"CDM"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68180015001","type":"CDM"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029407","type":"CDM"},{"code":"68180029407","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029509","type":"CDM"},{"code":"68180029509","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030260","type":"CDM"},{"code":"68180030260","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030360","type":"CDM"},{"code":"68180030360","type":"NDC"}],"standard_charges":[{"gross_charge":13.53,"discounted_cash":10.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180031906","type":"CDM"},{"code":"68180031906","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180035209","type":"CDM"},{"code":"68180035209","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BIMATOPROST OPHTH SOLN 0.03%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68180042901","type":"CDM"},{"code":"68180042901","type":"NDC"}],"standard_charges":[{"gross_charge":348.13,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68180043501","type":"CDM"},{"code":"68180043501","type":"NDC"}],"standard_charges":[{"gross_charge":392.79,"discounted_cash":294.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68180044101","type":"CDM"},{"code":"68180044101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68180044102","type":"CDM"},{"code":"68180044102","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051301","type":"CDM"},{"code":"68180051301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180065208","type":"CDM"},{"code":"68180065208","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180065906","type":"CDM"},{"code":"68180065906","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067511","type":"CDM"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067711","type":"CDM"},{"code":"68180067711","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx68180067801","type":"CDM"},{"code":"68180067801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx68180072204","type":"CDM"},{"code":"68180072204","type":"NDC"}],"standard_charges":[{"gross_charge":16.72,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx68180072305","type":"CDM"},{"code":"68180072305","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180085211","type":"CDM"},{"code":"68180085211","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096709","type":"CDM"},{"code":"68180096709","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096909","type":"CDM"},{"code":"68180096909","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180097009","type":"CDM"},{"code":"68180097009","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx68308015215","type":"CDM"},{"code":"68308015215","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN W/ DELAYED RELEASE PARTICLES CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68308025010","type":"CDM"},{"code":"68308025010","type":"NDC"}],"standard_charges":[{"gross_charge":20.02,"discounted_cash":15.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382007901","type":"CDM"},{"code":"68382007901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009201","type":"CDM"},{"code":"68382009201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009301","type":"CDM"},{"code":"68382009301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009501","type":"CDM"},{"code":"68382009501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382011214","type":"CDM"},{"code":"68382011214","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382011414","type":"CDM"},{"code":"68382011414","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382014014","type":"CDM"},{"code":"68382014014","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382030901","type":"CDM"},{"code":"68382030901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382030930","type":"CDM"},{"code":"68382030930","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031001","type":"CDM"},{"code":"68382031001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031030","type":"CDM"},{"code":"68382031030","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031101","type":"CDM"},{"code":"68382031101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031130","type":"CDM"},{"code":"68382031130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68382044405","type":"CDM"},{"code":"68382044405","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382052960","type":"CDM"},{"code":"68382052960","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382079801","type":"CDM"},{"code":"68382079801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68382086002","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"68382086002","type":"NDC"}],"standard_charges":[{"gross_charge":119.88,"discounted_cash":89.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68382086010","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"gross_charge":117.63,"discounted_cash":88.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382091001","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"68382091001","type":"NDC"}],"standard_charges":[{"gross_charge":157.35,"discounted_cash":118.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382091010","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"gross_charge":106.59,"discounted_cash":79.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462010230","type":"CDM"},{"code":"68462010230","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015713","type":"CDM"},{"code":"68462015713","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015740","type":"CDM"},{"code":"68462015740","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462018901","type":"CDM"},{"code":"68462018901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462025501","type":"CDM"},{"code":"68462025501","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026001","type":"CDM"},{"code":"68462026001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026290","type":"CDM"},{"code":"68462026290","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029201","type":"CDM"},{"code":"68462029201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029301","type":"CDM"},{"code":"68462029301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx68462029817","type":"CDM"},{"code":"68462029817","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462040560","type":"CDM"},{"code":"68462040560","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462040601","type":"CDM"},{"code":"68462040601","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx68462041820","type":"CDM"},{"code":"68462041820","type":"NDC"}],"standard_charges":[{"gross_charge":113.64,"discounted_cash":85.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462046940","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462046940","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462046954","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462046954","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062102","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062154","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062154","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062210","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062264","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062264","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68516521405","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68516521405","type":"NDC"}],"standard_charges":[{"gross_charge":756.43,"discounted_cash":567.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx68516521602","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":463.25,"discounted_cash":347.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521602","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":231.62,"discounted_cash":173.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521604","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521604","type":"NDC"}],"standard_charges":[{"gross_charge":252.88,"discounted_cash":189.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM CHLORIDE TAB DR 64 MG (ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68585000575","type":"CDM"},{"code":"68585000575","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68585000801","type":"CDM"},{"code":"68585000801","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68682046410","type":"CDM"},{"code":"68682046410","type":"NDC"}],"standard_charges":[{"gross_charge":635.19,"discounted_cash":476.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LURBINECTEDIN FOR IV SOLN 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68727071201","type":"CDM"},{"code":"J9223","type":"HCPCS"},{"code":"68727071201","type":"NDC"}],"standard_charges":[{"gross_charge":58692.56,"discounted_cash":44019.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRYPAN BLUE INTRAOCULAR SOLN PREF SYR 0.06%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68803061210","type":"CDM"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"gross_charge":227.33,"discounted_cash":170.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68817013450","type":"CDM"},{"code":"J9264","type":"HCPCS"},{"code":"68817013450","type":"NDC"}],"standard_charges":[{"gross_charge":10355.2,"discounted_cash":7766.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026101","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026101","type":"NDC"}],"standard_charges":[{"gross_charge":3415.39,"discounted_cash":2561.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026102","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026102","type":"NDC"}],"standard_charges":[{"gross_charge":7424.76,"discounted_cash":5568.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026181","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026181","type":"NDC"}],"standard_charges":[{"gross_charge":3712.38,"discounted_cash":2784.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026182","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026182","type":"NDC"}],"standard_charges":[{"gross_charge":7424.76,"discounted_cash":5568.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097039878","type":"CDM"},{"code":"J9264","type":"HCPCS"},{"code":"69097039878","type":"NDC"}],"standard_charges":[{"gross_charge":5604.17,"discounted_cash":4203.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx69097053731","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"69097053731","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097057967","type":"CDM"},{"code":"69097057967","type":"NDC"}],"standard_charges":[{"gross_charge":102.89,"discounted_cash":77.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EMTRICITABINE CAPS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097064202","type":"CDM"},{"code":"69097064202","type":"NDC"}],"standard_charges":[{"gross_charge":63.68,"discounted_cash":47.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097083037","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"69097083037","type":"NDC"}],"standard_charges":[{"gross_charge":412.45,"discounted_cash":309.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097084607","type":"CDM"},{"code":"69097084607","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097086107","type":"CDM"},{"code":"69097086107","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LANREOTIDE ACETATE EXTENDED RELEASE INJ 120 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx69097087067","type":"CDM"},{"code":"J1932","type":"HCPCS"},{"code":"69097087067","type":"NDC"}],"standard_charges":[{"gross_charge":20733.18,"discounted_cash":15549.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097096507","type":"CDM"},{"code":"69097096507","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NABUMETONE TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097096607","type":"CDM"},{"code":"69097096607","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097099902","type":"CDM"},{"code":"69097099902","type":"NDC"}],"standard_charges":[{"gross_charge":25.62,"discounted_cash":19.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx69238127306","type":"CDM"},{"code":"69238127306","type":"NDC"}],"standard_charges":[{"gross_charge":86.06,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131209","type":"CDM"},{"code":"69238131209","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238149001","type":"CDM"},{"code":"69238149001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx69238153405","type":"CDM"},{"code":"69238153405","type":"NDC"}],"standard_charges":[{"gross_charge":60.98,"discounted_cash":45.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLURBIPROFEN SODIUM OPHTH SOLN 0.03%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx69292072225","type":"CDM"},{"code":"69292072225","type":"NDC"}],"standard_charges":[{"gross_charge":148.41,"discounted_cash":111.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315012701","type":"CDM"},{"code":"69315012701","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx69315030615","type":"CDM"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx69315030802","type":"CDM"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx69315031228","type":"CDM"},{"code":"69315031228","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx69315032308","type":"CDM"},{"code":"69315032308","type":"NDC"}],"standard_charges":[{"gross_charge":57.97,"discounted_cash":43.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090401","type":"CDM"},{"code":"69315090401","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090501","type":"CDM"},{"code":"69315090501","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315091001","type":"CDM"},{"code":"69315091001","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx69339013815","type":"CDM"},{"code":"69339013815","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx69339013817","type":"CDM"},{"code":"69339013817","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339015001","type":"CDM"},{"code":"69339015001","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339015019","type":"CDM"},{"code":"69339015019","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339015105","type":"CDM"},{"code":"69339015105","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339015117","type":"CDM"},{"code":"69339015117","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69355041203","type":"CDM"},{"code":"69355041203","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SALSALATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367016004","type":"CDM"},{"code":"69367016004","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367022001","type":"CDM"},{"code":"69367022001","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx69374021450","type":"CDM"},{"code":"69374021450","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx69374031925","type":"CDM"},{"code":"69374031925","type":"NDC"}],"standard_charges":[{"gross_charge":169.79,"discounted_cash":127.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69374092005","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"69374092005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx69374092405","type":"CDM"},{"code":"69374092405","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx69374094604","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"69374094604","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx69374095350","type":"CDM"},{"code":"69374095350","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69387010701","type":"CDM"},{"code":"69387010701","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452015020","type":"CDM"},{"code":"69452015020","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452027130","type":"CDM"},{"code":"69452027130","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452033220","type":"CDM"},{"code":"69452033220","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GRANISETRON HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452035092","type":"CDM"},{"code":"Q0166","type":"HCPCS"},{"code":"69452035092","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69547062702","type":"CDM"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69584011110","type":"CDM"},{"code":"69584011110","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69680016700","type":"CDM"},{"code":"69680016700","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 312 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69800420301","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"69800420301","type":"NDC"}],"standard_charges":[{"gross_charge":3165.09,"discounted_cash":2373.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69918050105","type":"CDM"},{"code":"69918050105","type":"NDC"}],"standard_charges":[{"gross_charge":821.2,"discounted_cash":615.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx69918070001","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"69918070001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69918070002","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"69918070002","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx69918070025","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"69918070025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69918073501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69918073501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69918073510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69918073510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69918089901","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"69918089901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69918089910","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69918089911","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"69918089911","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE ORAL GRANULES","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx70000002101","type":"CDM"},{"code":"70000002101","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx70000005101","type":"CDM"},{"code":"70000005101","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000013501","type":"CDM"},{"code":"70000013501","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000021802","type":"CDM"},{"code":"70000021802","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000026901","type":"CDM"},{"code":"70000026901","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SALICYLIC ACID LIQUID 17%","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"Rx70000032901","type":"CDM"},{"code":"70000032901","type":"NDC"}],"standard_charges":[{"gross_charge":3.56,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx70000038801","type":"CDM"},{"code":"70000038801","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000043401","type":"CDM"},{"code":"70000043401","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000044702","type":"CDM"},{"code":"70000044702","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx70000045801","type":"CDM"},{"code":"70000045801","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":1.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70000047401","type":"CDM"},{"code":"70000047401","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx70000048501","type":"CDM"},{"code":"70000048501","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70000049201","type":"CDM"},{"code":"70000049201","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx70000055501","type":"CDM"},{"code":"70000055501","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000057201","type":"CDM"},{"code":"70000057201","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE-NACL IV SOLN 5 MG/250ML-0.9% (20 MCG/ML)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70004060840","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70004060840","type":"NDC"}],"standard_charges":[{"gross_charge":602.76,"discounted_cash":452.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE-NACL IV SOLN 5 MG/250ML-0.9% (20 MCG/ML)","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70004062840","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"70004062840","type":"NDC"}],"standard_charges":[{"gross_charge":602.76,"discounted_cash":452.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NAPROXEN TAB 375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010013801","type":"CDM"},{"code":"70010013801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010078101","type":"CDM"},{"code":"70010078101","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70069000510","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx70069002101","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx70069002125","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006125","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006325","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006325","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006401","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006410","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006425","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006425","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069007201","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069007210","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70069012101","type":"CDM"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":35.01,"discounted_cash":26.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70069018101","type":"CDM"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"gross_charge":131.95,"discounted_cash":98.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70069019101","type":"CDM"},{"code":"70069019101","type":"NDC"}],"standard_charges":[{"gross_charge":136.06,"discounted_cash":102.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069023101","type":"CDM"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70069026101","type":"CDM"},{"code":"70069026101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027101","type":"CDM"},{"code":"70069027101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027105","type":"CDM"},{"code":"70069027105","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70069036301","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"70069036301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069042101","type":"CDM"},{"code":"70069042101","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069042103","type":"CDM"},{"code":"70069042103","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRAVOPROST OPHTH SOLN 0.004% (BENZALKONIUM FREE) (BAK FREE)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069058601","type":"CDM"},{"code":"70069058601","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70092103305","type":"CDM"},{"code":"70092103305","type":"NDC"}],"standard_charges":[{"gross_charge":186.77,"discounted_cash":140.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx70092104646","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092104646","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx70092106807","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092106807","type":"NDC"}],"standard_charges":[{"gross_charge":101.87,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/250ML,FENTANYL CITRATE-NACL PF 0.9% IV SOLN 1 MG/100 ML (10 MCG/ML),FENTANYL CITRATE-NACL 0.9% INJ SOLN 1 MG/100ML,FENTANYL CITRATE-NACL 0.9% INJ SOLN 2.5 MG/250ML,FENTANYL CITRATE IV SOLN 1000 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092109236","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70092109236","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL-NACL SOLN PREF SY 50 MG/5ML-0.9% (10MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70092111944","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092111944","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE GEL 4-0.05-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.18-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.09-0.5%,LIDOCAINE HCL-RACEPINEPHRINE-TETRACAINE HCL GEL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70092113544","type":"CDM"},{"code":"70092113544","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIV-EPI-CLONID-KETOROLAC PREF SYR 123-0.25-0.04-15 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70092143350","type":"CDM"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":397.65,"discounted_cash":298.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70092145244","type":"CDM"},{"code":"70092145244","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN,LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN 4-0.05-0.5%,LIDOCAINE-RACEPINEPHRINE-TETRACAINE EXTERNAL SOL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70092165844","type":"CDM"},{"code":"70092165844","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL-NACL SOLN PREF SY 50 MG/5ML-0.9% (10MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70092911944","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092911944","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEGFILGRASTIM-CBQV SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx70114010101","type":"CDM"},{"code":"Q5111","type":"HCPCS"},{"code":"70114010101","type":"NDC"}],"standard_charges":[{"gross_charge":11141.27,"discounted_cash":8355.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121104901","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121104901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121104902","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121104905","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121104905","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70121118901","type":"CDM"},{"code":"70121118901","type":"NDC"}],"standard_charges":[{"gross_charge":126.14,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70121145401","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"70121145401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70121145407","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"70121145407","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121146302","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"70121146302","type":"NDC"}],"standard_charges":[{"gross_charge":232.97,"discounted_cash":174.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx70121155201","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121155201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121156801","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121156801","type":"NDC"}],"standard_charges":[{"gross_charge":592.93,"discounted_cash":444.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121156807","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121156807","type":"NDC"}],"standard_charges":[{"gross_charge":592.93,"discounted_cash":444.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx70121157001","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157001","type":"NDC"}],"standard_charges":[{"gross_charge":948.67,"discounted_cash":711.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx70121157007","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157007","type":"NDC"}],"standard_charges":[{"gross_charge":948.65,"discounted_cash":711.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70121157301","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70121157305","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx70121157401","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70121157601","type":"CDM"},{"code":"70121157601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70121157607","type":"CDM"},{"code":"70121157607","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157801","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157807","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157807","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70121160501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70121160501","type":"NDC"}],"standard_charges":[{"gross_charge":109.45,"discounted_cash":82.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70121160507","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70121160507","type":"NDC"}],"standard_charges":[{"gross_charge":108.23,"discounted_cash":81.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70121163701","type":"CDM"},{"code":"70121163701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70121163707","type":"CDM"},{"code":"70121163707","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121172001","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"70121172001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121172009","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"70121172009","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/250ML,FENTANYL CITRATE-NACL PF 0.9% IV SOLN 1 MG/100 ML (10 MCG/ML),FENTANYL CITRATE-NACL 0.9% INJ SOLN 1 MG/100ML,FENTANYL CITRATE-NACL 0.9% INJ SOLN 2.5 MG/250ML,FENTANYL CITRATE IV SOLN 1000 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70214501001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70214501001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx70214503001","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70214503001","type":"NDC"}],"standard_charges":[{"gross_charge":107.53,"discounted_cash":80.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70214504001","type":"CDM"},{"code":"70214504001","type":"NDC"}],"standard_charges":[{"gross_charge":195.26,"discounted_cash":146.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377001511","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"70377001511","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377006611","type":"CDM"},{"code":"70377006611","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377011412","type":"CDM"},{"code":"70377011412","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436001982","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002082","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436005801","type":"CDM"},{"code":"70436005801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436020201","type":"CDM"},{"code":"70436020201","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436020202","type":"CDM"},{"code":"70436020202","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461002503","type":"CDM"},{"code":"90653","type":"HCPCS"},{"code":"70461002503","type":"NDC"}],"standard_charges":[{"gross_charge":465.92,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461002504","type":"CDM"},{"code":"90653","type":"HCPCS"},{"code":"70461002504","type":"NDC"}],"standard_charges":[{"gross_charge":465.92,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLUENZA VIRUS VAC TISS-CULT SUBUNIT SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461065504","type":"CDM"},{"code":"90661","type":"HCPCS"},{"code":"70461065504","type":"NDC"}],"standard_charges":[{"gross_charge":186.62,"discounted_cash":139.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EDARAVONE INJ 30 MG/100ML (0.3 MG/ML)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx70510217101","type":"CDM"},{"code":"J1301","type":"HCPCS"},{"code":"70510217101","type":"NDC"}],"standard_charges":[{"gross_charge":4697.4,"discounted_cash":3523.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EDARAVONE INJ 30 MG/100ML (0.3 MG/ML)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx70510217102","type":"CDM"},{"code":"J1301","type":"HCPCS"},{"code":"70510217102","type":"NDC"}],"standard_charges":[{"gross_charge":4697.4,"discounted_cash":3523.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70512084001","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"70512084001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70512084025","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"70512084025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70512085905","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"70512085905","type":"NDC"}],"standard_charges":[{"gross_charge":154.03,"discounted_cash":115.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70594011101","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"70594011101","type":"NDC"}],"standard_charges":[{"gross_charge":179.65,"discounted_cash":134.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70594011102","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"70594011102","type":"NDC"}],"standard_charges":[{"gross_charge":154.58,"discounted_cash":115.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70594011201","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"70594011201","type":"NDC"}],"standard_charges":[{"gross_charge":136.33,"discounted_cash":102.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70594011202","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"70594011202","type":"NDC"}],"standard_charges":[{"gross_charge":134.24,"discounted_cash":100.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70594011401","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"70594011401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70594011402","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"70594011402","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70594011801","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"70594011801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70594012101","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"70594012101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594012201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594012201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594012202","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594012202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70655000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"70655000206","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70700016622","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70700016622","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70700016625","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70700016625","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70700017222","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"70700017222","type":"NDC"}],"standard_charges":[{"gross_charge":121.97,"discounted_cash":91.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70700017223","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"70700017223","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70700018622","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018622","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70700018623","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018623","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70700018822","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018822","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70700018922","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018922","type":"NDC"}],"standard_charges":[{"gross_charge":455.59,"discounted_cash":341.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70700026894","type":"CDM"},{"code":"70700026894","type":"NDC"}],"standard_charges":[{"gross_charge":232.78,"discounted_cash":174.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70700026899","type":"CDM"},{"code":"70700026899","type":"NDC"}],"standard_charges":[{"gross_charge":289.22,"discounted_cash":216.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70700028922","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"70700028922","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710100802","type":"CDM"},{"code":"70710100802","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710101403","type":"CDM"},{"code":"70710101403","type":"NDC"}],"standard_charges":[{"gross_charge":115.97,"discounted_cash":86.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BETAMETHASONE DIPROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx70710123301","type":"CDM"},{"code":"70710123301","type":"NDC"}],"standard_charges":[{"gross_charge":64.28,"discounted_cash":48.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70710137701","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"70710137701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70710137702","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"70710137702","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx70710147801","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":2404.57,"discounted_cash":1803.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710183301","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"70710183301","type":"NDC"}],"standard_charges":[{"gross_charge":341.43,"discounted_cash":256.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROLAPITANT HCL TAB THERAPY PACK 2 X 90 MG (BASE EQUIV)","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx70720010102","type":"CDM"},{"code":"J8670","type":"HCPCS"},{"code":"70720010102","type":"NDC"}],"standard_charges":[{"gross_charge":2965.87,"discounted_cash":2224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GOSERELIN ACETATE IMPLANT 3.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70720095036","type":"CDM"},{"code":"J9202","type":"HCPCS"},{"code":"70720095036","type":"NDC"}],"standard_charges":[{"gross_charge":7996.05,"discounted_cash":5997.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GOSERELIN ACETATE IMPLANT 10.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70720095130","type":"CDM"},{"code":"J9202","type":"HCPCS"},{"code":"70720095130","type":"NDC"}],"standard_charges":[{"gross_charge":21999.4,"discounted_cash":16499.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70748032301","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"70748032301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70748032310","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"70748032310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx70752011303","type":"CDM"},{"code":"70752011303","type":"NDC"}],"standard_charges":[{"gross_charge":35.86,"discounted_cash":26.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001402","type":"CDM"},{"code":"70756001402","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001405","type":"CDM"},{"code":"70756001405","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756021590","type":"CDM"},{"code":"70756021590","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756040411","type":"CDM"},{"code":"70756040411","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756060505","type":"CDM"},{"code":"70756060505","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756060525","type":"CDM"},{"code":"70756060525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756060582","type":"CDM"},{"code":"70756060582","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756060730","type":"CDM"},{"code":"70756060730","type":"NDC"}],"standard_charges":[{"gross_charge":39.62,"discounted_cash":29.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70756061125","type":"CDM"},{"code":"70756061125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756061430","type":"CDM"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":76.18,"discounted_cash":57.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756062182","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70756062182","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756062210","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70756062210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70756062925","type":"CDM"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":57.7,"discounted_cash":43.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064125","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064185","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064185","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064625","type":"CDM"},{"code":"70756064625","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064687","type":"CDM"},{"code":"70756064687","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064825","type":"CDM"},{"code":"70756064825","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064887","type":"CDM"},{"code":"70756064887","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756070360","type":"CDM"},{"code":"70756070360","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"COCAINE HCL NASAL SOLN 40 MG/ML (4%)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70839036204","type":"CDM"},{"code":"C9046","type":"HCPCS"},{"code":"70839036204","type":"NDC"}],"standard_charges":[{"gross_charge":2056.66,"discounted_cash":1542.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010010","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860010010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010041","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860010041","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010410","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70860010410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010520","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70860010520","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860012541","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860012541","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860012566","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860012566","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70860020050","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"70860020050","type":"NDC"}],"standard_charges":[{"gross_charge":262.69,"discounted_cash":197.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860020550","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"70860020550","type":"NDC"}],"standard_charges":[{"gross_charge":130.08,"discounted_cash":97.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 4 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70860021051","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"70860021051","type":"NDC"}],"standard_charges":[{"gross_charge":96.21,"discounted_cash":72.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860021141","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"70860021141","type":"NDC"}],"standard_charges":[{"gross_charge":2281.4,"discounted_cash":1711.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860021174","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"70860021174","type":"NDC"}],"standard_charges":[{"gross_charge":393.7,"discounted_cash":295.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx70860030005","type":"CDM"},{"code":"70860030005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx70860030041","type":"CDM"},{"code":"70860030041","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860030105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860030105","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860030141","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860030141","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70860030202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"70860030202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70860030606","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860030606","type":"NDC"}],"standard_charges":[{"gross_charge":188.16,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860040504","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"70860040504","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860040541","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"70860040541","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx70860070100","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"70860070100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70860075102","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"70860075102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70860075141","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"70860075141","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860077802","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"70860077802","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70954025810","type":"CDM"},{"code":"70954025810","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx70954031610","type":"CDM"},{"code":"70954031610","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954044410","type":"CDM"},{"code":"70954044410","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954044420","type":"CDM"},{"code":"70954044420","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954056510","type":"CDM"},{"code":"70954056510","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx71019022213","type":"CDM"},{"code":"71019022213","type":"NDC"}],"standard_charges":[{"gross_charge":498.05,"discounted_cash":373.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-PHENYLEPH-BSS INTRAOCULAR PREF SYR 1-1.5% (1 ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71266635001","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71266635001","type":"NDC"}],"standard_charges":[{"gross_charge":97.26,"discounted_cash":72.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE-PHENYLEPH-BSS INTRAOCULAR PREF SYR 1-1.5% (1 ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71266636001","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71266636001","type":"NDC"}],"standard_charges":[{"gross_charge":97.26,"discounted_cash":72.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288000630","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288000630","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288000631","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288000631","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288001615","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"gross_charge":104.3,"discounted_cash":78.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288001695","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"71288001695","type":"NDC"}],"standard_charges":[{"gross_charge":107.53,"discounted_cash":80.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002211","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002211","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002320","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002320","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002321","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002810","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"71288002810","type":"NDC"}],"standard_charges":[{"gross_charge":169.13,"discounted_cash":126.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002811","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"71288002811","type":"NDC"}],"standard_charges":[{"gross_charge":136.28,"discounted_cash":102.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003220","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003220","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003221","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003221","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003291","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003291","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003292","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003292","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288010110","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"71288010110","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx71288010120","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"71288010120","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BLEOMYCIN SULFATE FOR INJ 30 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288010720","type":"CDM"},{"code":"J9040","type":"HCPCS"},{"code":"71288010720","type":"NDC"}],"standard_charges":[{"gross_charge":366.24,"discounted_cash":274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288011450","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011450","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.26,"type":"ML"},"code_information":[{"code":"Rx71288011706","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011706","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx71288011728","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011728","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GEMCITABINE HCL INJ 2 GM/52.6ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":52.6,"type":"ML"},"code_information":[{"code":"Rx71288011754","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011754","type":"NDC"}],"standard_charges":[{"gross_charge":156.53,"discounted_cash":117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016120","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"71288016120","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016230","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"71288016230","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016330","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"71288016330","type":"NDC"}],"standard_charges":[{"gross_charge":118.42,"discounted_cash":88.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016450","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"71288016450","type":"NDC"}],"standard_charges":[{"gross_charge":377.51,"discounted_cash":283.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016610","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016610","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016691","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016691","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016750","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016750","type":"NDC"}],"standard_charges":[{"gross_charge":345.15,"discounted_cash":258.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016795","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016795","type":"NDC"}],"standard_charges":[{"gross_charge":355.73,"discounted_cash":266.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288017420","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"71288017420","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288017421","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"71288017421","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020310","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020311","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020311","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx71288030301","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"71288030301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx71288030302","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"71288030302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040202","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040211","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx71288040301","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx71288040302","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288040905","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"71288040905","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288041082","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041082","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288041083","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041083","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx71288041181","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041181","type":"NDC"}],"standard_charges":[{"gross_charge":110.94,"discounted_cash":83.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041402","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041402","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041404","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041404","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288042710","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"71288042710","type":"NDC"}],"standard_charges":[{"gross_charge":255.5,"discounted_cash":191.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288042711","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"71288042711","type":"NDC"}],"standard_charges":[{"gross_charge":255.31,"discounted_cash":191.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288043382","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043382","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288043383","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288060010","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"71288060010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288060011","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288070005","type":"CDM"},{"code":"71288070005","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288070006","type":"CDM"},{"code":"71288070006","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288072232","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"71288072232","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288072652","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"71288072652","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288073420","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"71288073420","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288073421","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"71288073421","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx71288080651","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"71288080651","type":"NDC"}],"standard_charges":[{"gross_charge":306.75,"discounted_cash":230.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288080875","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080875","type":"NDC"}],"standard_charges":[{"gross_charge":149.45,"discounted_cash":112.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288080876","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080876","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VUTRISIRAN SODIUM SOLN PREFILLED SYRINGE 25 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71336100301","type":"CDM"},{"code":"J0225","type":"HCPCS"},{"code":"71336100301","type":"NDC"}],"standard_charges":[{"gross_charge":521266.68,"discounted_cash":390950.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71351001760","type":"CDM"},{"code":"71351001760","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL GEL 2%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx71351002530","type":"CDM"},{"code":"71351002530","type":"NDC"}],"standard_charges":[{"gross_charge":24.29,"discounted_cash":18.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM CITRATE SOLN","drug_information":{"unit":148.0,"type":"ML"},"code_information":[{"code":"Rx71399005101","type":"CDM"},{"code":"71399005101","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASCORBIC ACID INJ 500 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71414011501","type":"CDM"},{"code":"71414011501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx71449000115","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449000115","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71449000411","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449000411","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL SOLN PREF SYR 50 MG/5ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71449006811","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449006811","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL-PHENYLEPHRINE HCL INTRAOCULAR SOLN 1-1.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71449009042","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449009042","type":"NDC"}],"standard_charges":[{"gross_charge":155.39,"discounted_cash":116.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MOXIFLOXACIN HCL IN BSS INTRAVITREAL SOLN 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71449009642","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449009642","type":"NDC"}],"standard_charges":[{"gross_charge":179.58,"discounted_cash":134.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx71449012615","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"71449012615","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71839012401","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71839012401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71839012425","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71839012425","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM ORAL SOLUTION 100 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71858013005","type":"CDM"},{"code":"71858013005","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":15.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72078003300","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"72078003300","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72078003302","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"72078003302","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205003960","type":"CDM"},{"code":"72205003960","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205005401","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"72205005401","type":"NDC"}],"standard_charges":[{"gross_charge":104.81,"discounted_cash":78.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx72205006301","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"72205006301","type":"NDC"}],"standard_charges":[{"gross_charge":197.5,"discounted_cash":148.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72241002305","type":"CDM"},{"code":"72241002305","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72266010301","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72266010301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72266010341","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72266010341","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011801","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011825","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011901","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011925","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011925","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72266014601","type":"CDM"},{"code":"72266014601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72266014610","type":"CDM"},{"code":"72266014610","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx72266015201","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"72266015201","type":"NDC"}],"standard_charges":[{"gross_charge":633.09,"discounted_cash":474.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx72266016201","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"72266016201","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72266019701","type":"CDM"},{"code":"72266019701","type":"NDC"}],"standard_charges":[{"gross_charge":62.73,"discounted_cash":47.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72266024201","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"72266024201","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72266024205","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"72266024205","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx72266025301","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"72266025301","type":"NDC"}],"standard_charges":[{"gross_charge":205.55,"discounted_cash":154.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72485010101","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"72485010101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72485010125","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72485010501","type":"CDM"},{"code":"72485010501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485010805","type":"CDM"},{"code":"72485010805","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485020101","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"72485020101","type":"NDC"}],"standard_charges":[{"gross_charge":133.3,"discounted_cash":99.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041701","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485042201","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72485042201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485042210","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx72485050201","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"72485050201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx72485050210","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"72485050210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485050401","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"72485050401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485050425","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"72485050425","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72485050510","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"72485050510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572001701","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72572001701","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572001710","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72572001710","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572005501","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"72572005501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572005525","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"72572005525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx72572007601","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"72572007601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx72572007624","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"72572007624","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572010201","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"72572010201","type":"NDC"}],"standard_charges":[{"gross_charge":186.84,"discounted_cash":140.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012001","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012025","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012201","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012225","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572014001","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"72572014001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572014002","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"72572014002","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017025","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017025","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017101","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017125","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017125","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572022501","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"72572022501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572022525","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"72572022525","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572032101","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"72572032101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572032110","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"72572032110","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572035001","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72572035001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037025","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037201","type":"CDM"},{"code":"72572037201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037225","type":"CDM"},{"code":"72572037225","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572038001","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"72572038001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572038025","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"72572038025","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572041401","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72572041401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572041410","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72572041410","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041501","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041501","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041510","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx72572042001","type":"CDM"},{"code":"72572042001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx72572042010","type":"CDM"},{"code":"72572042010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572043001","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043001","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572043025","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043025","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572043201","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043201","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572043210","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043210","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572045001","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"72572045001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572045025","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"72572045025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572046201","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"72572046201","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572046210","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"72572046210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572052001","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72572052001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572052025","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72572052025","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055001","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055010","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055301","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055310","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572057301","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72572057301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72572057310","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72572057310","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx72572074001","type":"CDM"},{"code":"72572074001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx72572074020","type":"CDM"},{"code":"72572074020","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx72572075001","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"72572075001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx72572075010","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"72572075010","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572080301","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72572080301","type":"NDC"}],"standard_charges":[{"gross_charge":120.43,"discounted_cash":90.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BETAMETHASONE DIPROPIONATE OINT 0.05%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx72578009306","type":"CDM"},{"code":"72578009306","type":"NDC"}],"standard_charges":[{"gross_charge":171.81,"discounted_cash":128.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BEVACIZUMAB-ADCD IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx72606001101","type":"CDM"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001101","type":"NDC"}],"standard_charges":[{"gross_charge":3572.93,"discounted_cash":2679.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BEVACIZUMAB-ADCD IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx72606001201","type":"CDM"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001201","type":"NDC"}],"standard_charges":[{"gross_charge":13322.79,"discounted_cash":9992.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611071601","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"72611071601","type":"NDC"}],"standard_charges":[{"gross_charge":846.23,"discounted_cash":634.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611071672","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"72611071672","type":"NDC"}],"standard_charges":[{"gross_charge":854.82,"discounted_cash":641.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72611074101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72611074101","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx72611074125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72611074125","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076101","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076110","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888001001","type":"CDM"},{"code":"72888001001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRALATREXATE IV INJ 40 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72893000501","type":"CDM"},{"code":"J9307","type":"HCPCS"},{"code":"72893000501","type":"NDC"}],"standard_charges":[{"gross_charge":109120.22,"discounted_cash":81840.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"UBLITUXIMAB-XIIY SOLN FOR IV INFUSION 150 MG/6ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx73150015006","type":"CDM"},{"code":"J2329","type":"HCPCS"},{"code":"73150015006","type":"NDC"}],"standard_charges":[{"gross_charge":48280.41,"discounted_cash":36210.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx73293000101","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"73293000101","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx73293000102","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"73293000102","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ULIPRISTAL ACETATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73302045601","type":"CDM"},{"code":"73302045601","type":"NDC"}],"standard_charges":[{"gross_charge":159.78,"discounted_cash":119.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EFGARTIGIMOD ALFA-FCAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx73475304105","type":"CDM"},{"code":"J9332","type":"HCPCS"},{"code":"73475304105","type":"NDC"}],"standard_charges":[{"gross_charge":26373.9,"discounted_cash":19780.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"FERRIC DERISOMALTOSE (ONE DOSE) IV SOL 1000 MG/10ML (FE EQ)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx73594931001","type":"CDM"},{"code":"J1437","type":"HCPCS"},{"code":"73594931001","type":"NDC"}],"standard_charges":[{"gross_charge":9026.76,"discounted_cash":6770.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx73702012510","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"73702012510","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx73702020202","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"73702020202","type":"NDC"}],"standard_charges":[{"gross_charge":145.86,"discounted_cash":109.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"KETAMINE HCL-NACL SOLN PREF SY 50 MG/5ML-0.9% (10MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx73702030115","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"73702030115","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZINC OXIDE PASTE 40%","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx74300000070","type":"CDM"},{"code":"74300000070","type":"NDC"}],"standard_charges":[{"gross_charge":5.97,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIPTORELIN PAMOATE FOR IM SUSP 22.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74676590600","type":"CDM"},{"code":"J3315","type":"HCPCS"},{"code":"74676590600","type":"NDC"}],"standard_charges":[{"gross_charge":31468.0,"discounted_cash":23601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRIPTORELIN PAMOATE FOR IM SUSP 22.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74676590601","type":"CDM"},{"code":"J3315","type":"HCPCS"},{"code":"74676590601","type":"NDC"}],"standard_charges":[{"gross_charge":31468.0,"discounted_cash":23601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75826011510","type":"CDM"},{"code":"75826011510","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834015801","type":"CDM"},{"code":"75834015801","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834015901","type":"CDM"},{"code":"75834015901","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ERYTHROMYCIN W/ DELAYED RELEASE PARTICLES CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75907007601","type":"CDM"},{"code":"75907007601","type":"NDC"}],"standard_charges":[{"gross_charge":20.02,"discounted_cash":15.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 1 GM/5ML (200 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx75907019007","type":"CDM"},{"code":"J9073","type":"HCPCS"},{"code":"75907019007","type":"NDC"}],"standard_charges":[{"gross_charge":1528.01,"discounted_cash":1146.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000401","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000401","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx76045000410","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000410","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000411","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx76045000501","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000501","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx76045000501","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000501","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx76045000511","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx76045000511","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000901","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000901","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000906","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000910","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000910","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000911","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000996","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000996","type":"NDC"}],"standard_charges":[{"gross_charge":97.62,"discounted_cash":73.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARFILZOMIB FOR INJ 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76075010101","type":"CDM"},{"code":"J9047","type":"HCPCS"},{"code":"76075010101","type":"NDC"}],"standard_charges":[{"gross_charge":25161.99,"discounted_cash":18871.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNIT/10ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx76125015002","type":"CDM"},{"code":"90377","type":"HCPCS"},{"code":"76125015002","type":"NDC"}],"standard_charges":[{"gross_charge":2767.34,"discounted_cash":2075.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76125079210","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"76125079210","type":"NDC"}],"standard_charges":[{"gross_charge":248.48,"discounted_cash":186.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76125079211","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"76125079211","type":"NDC"}],"standard_charges":[{"gross_charge":248.48,"discounted_cash":186.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204002260","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"76204002260","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx76204010001","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx76204020001","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204030003","type":"CDM"},{"code":"76204030003","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204060001","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090001","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090011","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090011","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76329124001","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"gross_charge":160.42,"discounted_cash":120.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx76329146901","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"76329146901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329301305","type":"CDM"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":35.39,"discounted_cash":26.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx76329301505","type":"CDM"},{"code":"76329301505","type":"NDC"}],"standard_charges":[{"gross_charge":50.09,"discounted_cash":37.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330101","type":"CDM"},{"code":"76329330101","type":"NDC"}],"standard_charges":[{"gross_charge":134.99,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330201","type":"CDM"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"gross_charge":147.87,"discounted_cash":110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329330401","type":"CDM"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS 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":"Rx76329331601","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"76329331601","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76329331801","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx76329334001","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329335201","type":"CDM"},{"code":"76329335201","type":"NDC"}],"standard_charges":[{"gross_charge":119.47,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx76329336901","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329339001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76385012301","type":"CDM"},{"code":"76385012301","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333003120","type":"CDM"},{"code":"77333003120","type":"NDC"}],"standard_charges":[{"gross_charge":0.6,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333003125","type":"CDM"},{"code":"77333003125","type":"NDC"}],"standard_charges":[{"gross_charge":0.6,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333004920","type":"CDM"},{"code":"77333004920","type":"NDC"}],"standard_charges":[{"gross_charge":0.6,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333004925","type":"CDM"},{"code":"77333004925","type":"NDC"}],"standard_charges":[{"gross_charge":0.6,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333030810","type":"CDM"},{"code":"77333030810","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333030825","type":"CDM"},{"code":"77333030825","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333051610","type":"CDM"},{"code":"77333051610","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333051625","type":"CDM"},{"code":"77333051625","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333071510","type":"CDM"},{"code":"77333071510","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333071525","type":"CDM"},{"code":"77333071525","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333081210","type":"CDM"},{"code":"77333081210","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333081225","type":"CDM"},{"code":"77333081225","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333082710","type":"CDM"},{"code":"77333082710","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333082725","type":"CDM"},{"code":"77333082725","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083510","type":"CDM"},{"code":"77333083510","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083525","type":"CDM"},{"code":"77333083525","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333084410","type":"CDM"},{"code":"77333084410","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333086110","type":"CDM"},{"code":"77333086110","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333086125","type":"CDM"},{"code":"77333086125","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333093410","type":"CDM"},{"code":"77333093410","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333093425","type":"CDM"},{"code":"77333093425","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333093710","type":"CDM"},{"code":"77333093710","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333093725","type":"CDM"},{"code":"77333093725","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333094010","type":"CDM"},{"code":"77333094010","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333094025","type":"CDM"},{"code":"77333094025","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333095110","type":"CDM"},{"code":"77333095110","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333095125","type":"CDM"},{"code":"77333095125","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333098310","type":"CDM"},{"code":"77333098310","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333098325","type":"CDM"},{"code":"77333098325","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx78112001103","type":"CDM"},{"code":"78112001103","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx78112073623","type":"CDM"},{"code":"78112073623","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011403","type":"CDM"},{"code":"78206011403","type":"NDC"}],"standard_charges":[{"gross_charge":159.78,"discounted_cash":119.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011404","type":"CDM"},{"code":"78206011404","type":"NDC"}],"standard_charges":[{"gross_charge":414.11,"discounted_cash":310.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 110 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011501","type":"CDM"},{"code":"78206011501","type":"NDC"}],"standard_charges":[{"gross_charge":383.43,"discounted_cash":287.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx78206011801","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206016201","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016201","type":"NDC"}],"standard_charges":[{"gross_charge":2241.76,"discounted_cash":1681.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206016299","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016299","type":"NDC"}],"standard_charges":[{"gross_charge":2142.57,"discounted_cash":1606.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETYLCYSTEINE CAP 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx79854040975","type":"CDM"},{"code":"79854040975","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx80196056775","type":"CDM"},{"code":"80196056775","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681000800","type":"CDM"},{"code":"80681000800","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681004100","type":"CDM"},{"code":"80681004100","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681007100","type":"CDM"},{"code":"80681007100","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM CITRATE TAB 950 MG (200 MG ELEMENTAL CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681014000","type":"CDM"},{"code":"80681014000","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681016900","type":"CDM"},{"code":"80681016900","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681017200","type":"CDM"},{"code":"80681017200","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx80830167201","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"80830167201","type":"NDC"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx80830167202","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"80830167202","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx80830232901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"80830232901","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx80830232902","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"80830232902","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx81284041100","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"81284041100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx81284041105","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"81284041105","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx81284041110","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"81284041110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061100","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061100","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061110","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061110","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061200","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061200","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061210","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061210","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx81298965901","type":"CDM"},{"code":"81298965901","type":"NDC"}],"standard_charges":[{"gross_charge":206.58,"discounted_cash":154.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx81298965903","type":"CDM"},{"code":"81298965903","type":"NDC"}],"standard_charges":[{"gross_charge":186.77,"discounted_cash":140.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx81665010310","type":"CDM"},{"code":"81665010310","type":"NDC"}],"standard_charges":[{"gross_charge":15.09,"discounted_cash":11.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx81665020001","type":"CDM"},{"code":"81665020001","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347050504","type":"CDM"},{"code":"82347050504","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347050505","type":"CDM"},{"code":"82347050505","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 1% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82667020001","type":"CDM"},{"code":"82667020001","type":"NDC"}],"standard_charges":[{"gross_charge":114.33,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83090000801","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"83090000801","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":84.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"TRASTUZUMAB-DKST FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83257000412","type":"CDM"},{"code":"Q5114","type":"HCPCS"},{"code":"83257000412","type":"NDC"}],"standard_charges":[{"gross_charge":5113.53,"discounted_cash":3835.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PEGFILGRASTIM-JMDB SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx83257000541","type":"CDM"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"gross_charge":4425.2,"discounted_cash":3318.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"INSULIN GLARGINE-YFGN INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx83257001411","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"83257001411","type":"NDC"}],"standard_charges":[{"gross_charge":601.97,"discounted_cash":451.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx83634077902","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"83634077902","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx83634077941","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"83634077941","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"WHITE PETROLATUM OINTMENT","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx84389011138","type":"CDM"},{"code":"84389011138","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"SODIUM HYALURONATE INTRA-ARTICULAR SOLN PREF SYR 25 MG/2.5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx89130444401","type":"CDM"},{"code":"J7321","type":"HCPCS"},{"code":"89130444401","type":"NDC"}],"standard_charges":[{"gross_charge":1376.77,"discounted_cash":1032.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"LANOLIN CREAM","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"Rx89165000701","type":"CDM"},{"code":"89165000701","type":"NDC"}],"standard_charges":[{"gross_charge":9.22,"discounted_cash":6.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295013533","type":"CDM"},{"code":"96295013533","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295013573","type":"CDM"},{"code":"96295013573","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295013892","type":"CDM"},{"code":"96295013892","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"ACETYLCYSTEINE CAP 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295014038","type":"CDM"},{"code":"96295014038","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION"}]},{"description":"K-WIRE STYLE 7 - 1.1MM X 102MM","code_information":[{"code":"Sx00-0186-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725214","type":"LOCAL"},{"code":"736661","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.62,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 725214 = Hospital System Supply Identifier | 736661 = Lawson ID"}]},{"description":"K-WIRE STYLE 1 - 1.6MM X 229MM","code_information":[{"code":"Sx00-0186-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725212","type":"LOCAL"},{"code":"736659","type":"LOCAL"}],"standard_charges":[{"gross_charge":23.62,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 725212 = Hospital System Supply Identifier | 736659 = Lawson ID"}]},{"description":"PLATE L1 ORTHOG BSSO LADR 39MM","code_information":[{"code":"Sx00-020-09-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779930","type":"LOCAL"},{"code":"773375","type":"LOCAL"}],"standard_charges":[{"gross_charge":807.79,"discounted_cash":605.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 779930 = Hospital System Supply Identifier | 773375 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36003","type":"LOCAL"},{"code":"245971","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 36003 = Hospital System Supply Identifier | 245971 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36002","type":"LOCAL"},{"code":"245970","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 36002 = Hospital System Supply Identifier | 245970 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 6IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36001","type":"LOCAL"},{"code":"245961","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 36001 = Hospital System Supply Identifier | 245961 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36000","type":"LOCAL"},{"code":"245960","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 36000 = Hospital System Supply Identifier | 245960 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35999","type":"LOCAL"},{"code":"245959","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35999 = Hospital System Supply Identifier | 245959 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35998","type":"LOCAL"},{"code":"245958","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35998 = Hospital System Supply Identifier | 245958 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35997","type":"LOCAL"},{"code":"245957","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35997 = Hospital System Supply Identifier | 245957 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35995","type":"LOCAL"},{"code":"245955","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35995 = Hospital System Supply Identifier | 245955 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35994","type":"LOCAL"},{"code":"245954","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35994 = Hospital System Supply Identifier | 245954 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35993","type":"LOCAL"},{"code":"245953","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35993 = Hospital System Supply Identifier | 245953 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35991","type":"LOCAL"},{"code":"245951","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35991 = Hospital System Supply Identifier | 245951 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35990","type":"LOCAL"},{"code":"245950","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35990 = Hospital System Supply Identifier | 245950 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35989","type":"LOCAL"},{"code":"245949","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35989 = Hospital System Supply Identifier | 245949 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"35992","type":"LOCAL"},{"code":"245952","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35992 = Hospital System Supply Identifier | 245952 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35996","type":"LOCAL"},{"code":"245956","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35996 = Hospital System Supply Identifier | 245956 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408066","type":"LOCAL"},{"code":"245943","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408066 = Hospital System Supply Identifier | 245943 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408069","type":"LOCAL"},{"code":"245946","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408069 = Hospital System Supply Identifier | 245946 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408068","type":"LOCAL"},{"code":"245945","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408068 = Hospital System Supply Identifier | 245945 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408067","type":"LOCAL"},{"code":"245944","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408067 = Hospital System Supply Identifier | 245944 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408065","type":"LOCAL"},{"code":"245942","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408065 = Hospital System Supply Identifier | 245942 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408064","type":"LOCAL"},{"code":"245941","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408064 = Hospital System Supply Identifier | 245941 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408057","type":"LOCAL"},{"code":"245920","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408057 = Hospital System Supply Identifier | 245920 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408061","type":"LOCAL"},{"code":"245927","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408061 = Hospital System Supply Identifier | 245927 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408058","type":"LOCAL"},{"code":"245922","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408058 = Hospital System Supply Identifier | 245922 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408070","type":"LOCAL"},{"code":"245947","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408070 = Hospital System Supply Identifier | 245947 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408072","type":"LOCAL"},{"code":"245969","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408072 = Hospital System Supply Identifier | 245969 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408060","type":"LOCAL"},{"code":"245926","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408060 = Hospital System Supply Identifier | 245926 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408059","type":"LOCAL"},{"code":"245923","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408059 = Hospital System Supply Identifier | 245923 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408063","type":"LOCAL"},{"code":"245940","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408063 = Hospital System Supply Identifier | 245940 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 6IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408071","type":"LOCAL"},{"code":"245948","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.37,"discounted_cash":192.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408071 = Hospital System Supply Identifier | 245948 = Lawson ID"}]},{"description":"DISC - PIN STNMN 2.4MMX60CM","code_information":[{"code":"Sx00-0409-021","type":"CDM"},{"code":"272","type":"RC"},{"code":"410428","type":"LOCAL"},{"code":"417181","type":"LOCAL"}],"standard_charges":[{"gross_charge":263.7,"discounted_cash":197.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 410428 = Hospital System Supply Identifier | 417181 = Lawson ID"}]},{"description":"PIN STEINMANN 3.2X60","code_information":[{"code":"Sx00-0409-022","type":"CDM"},{"code":"272","type":"RC"},{"code":"411088","type":"LOCAL"},{"code":"437117","type":"LOCAL"}],"standard_charges":[{"gross_charge":304.72,"discounted_cash":228.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411088 = Hospital System Supply Identifier | 437117 = Lawson ID"}]},{"description":"PIN STNMN 4.0MMX60CM","code_information":[{"code":"Sx00-0409-023","type":"CDM"},{"code":"272","type":"RC"},{"code":"410429","type":"LOCAL"},{"code":"417182","type":"LOCAL"}],"standard_charges":[{"gross_charge":304.72,"discounted_cash":228.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 410429 = Hospital System Supply Identifier | 417182 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM 6MM NSTRL BULLET TIP ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-034","type":"CDM"},{"code":"272","type":"RC"},{"code":"410441","type":"LOCAL"},{"code":"418220","type":"LOCAL"}],"standard_charges":[{"gross_charge":527.4,"discounted_cash":395.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 410441 = Hospital System Supply Identifier | 418220 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-042","type":"CDM"},{"code":"272","type":"RC"},{"code":"409623","type":"LOCAL"},{"code":"402333","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 409623 = Hospital System Supply Identifier | 402333 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-043","type":"CDM"},{"code":"272","type":"RC"},{"code":"409624","type":"LOCAL"},{"code":"402334","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 409624 = Hospital System Supply Identifier | 402334 = Lawson ID"}]},{"description":"DISC - COLLAR CERV SERP MED XLNG 3.5","code_information":[{"code":"Sx00-0737-005","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"35006","type":"LOCAL"},{"code":"106778","type":"LOCAL"}],"standard_charges":[{"gross_charge":33.32,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35006 = Hospital System Supply Identifier | 106778 = Lawson ID"}]},{"description":"DUP USE S13371 - PIN RUSH MEDUL 1/4 801-01-03","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1173319","type":"LOCAL"},{"code":"245931","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":23.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1173319 = Hospital System Supply Identifier | 245931 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZH","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408055","type":"LOCAL"},{"code":"245914","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408055 = Hospital System Supply Identifier | 245914 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZG","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408054","type":"LOCAL"},{"code":"245913","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408054 = Hospital System Supply Identifier | 245913 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZF","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408053","type":"LOCAL"},{"code":"245912","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408053 = Hospital System Supply Identifier | 245912 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZE","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408052","type":"LOCAL"},{"code":"245911","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408052 = Hospital System Supply Identifier | 245911 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZI","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408056","type":"LOCAL"},{"code":"245915","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408056 = Hospital System Supply Identifier | 245915 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZC","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408050","type":"LOCAL"},{"code":"245909","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408050 = Hospital System Supply Identifier | 245909 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-1","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35272","type":"LOCAL"},{"code":"142730","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35272 = Hospital System Supply Identifier | 142730 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 28CMX6.4MM","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53562","type":"LOCAL"},{"code":"116024","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53562 = Hospital System Supply Identifier | 116024 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-2","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35037","type":"LOCAL"},{"code":"116023","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35037 = Hospital System Supply Identifier | 116023 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZD","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408051","type":"LOCAL"},{"code":"245910","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408051 = Hospital System Supply Identifier | 245910 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY L 41.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408422","type":"LOCAL"},{"code":"328029","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408422 = Hospital System Supply Identifier | 328029 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-03","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407861","type":"LOCAL"},{"code":"206200","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407861 = Hospital System Supply Identifier | 206200 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-10","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407863","type":"LOCAL"},{"code":"206202","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407863 = Hospital System Supply Identifier | 206202 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-09","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407862","type":"LOCAL"},{"code":"206201","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407862 = Hospital System Supply Identifier | 206201 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-08","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407484","type":"LOCAL"},{"code":"147124","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407484 = Hospital System Supply Identifier | 147124 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 20.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53559","type":"LOCAL"},{"code":"116019","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53559 = Hospital System Supply Identifier | 116019 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY D 26CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166633","type":"LOCAL"},{"code":"147122","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 166633 = Hospital System Supply Identifier | 147122 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 3/16 802-01-06","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"55025","type":"LOCAL"},{"code":"142731","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 55025 = Hospital System Supply Identifier | 142731 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-04","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53560","type":"LOCAL"},{"code":"116020","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53560 = Hospital System Supply Identifier | 116020 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-07","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166634","type":"LOCAL"},{"code":"147123","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 166634 = Hospital System Supply Identifier | 147123 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-14","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168155","type":"LOCAL"},{"code":"206187","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168155 = Hospital System Supply Identifier | 206187 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 1/8 803-01-11","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168153","type":"LOCAL"},{"code":"206185","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168153 = Hospital System Supply Identifier | 206185 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-10","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168152","type":"LOCAL"},{"code":"206184","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168152 = Hospital System Supply Identifier | 206184 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-07","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168151","type":"LOCAL"},{"code":"206183","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168151 = Hospital System Supply Identifier | 206183 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-04","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168150","type":"LOCAL"},{"code":"206182","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168150 = Hospital System Supply Identifier | 206182 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-03","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168149","type":"LOCAL"},{"code":"206181","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168149 = Hospital System Supply Identifier | 206181 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-13","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168154","type":"LOCAL"},{"code":"206186","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168154 = Hospital System Supply Identifier | 206186 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-08","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166637","type":"LOCAL"},{"code":"147128","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 166637 = Hospital System Supply Identifier | 147128 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-06","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166636","type":"LOCAL"},{"code":"147127","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 166636 = Hospital System Supply Identifier | 147127 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-05","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407485","type":"LOCAL"},{"code":"147126","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407485 = Hospital System Supply Identifier | 147126 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-02","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166635","type":"LOCAL"},{"code":"147125","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 166635 = Hospital System Supply Identifier | 147125 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-12","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53561","type":"LOCAL"},{"code":"116021","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53561 = Hospital System Supply Identifier | 116021 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-09","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166638","type":"LOCAL"},{"code":"147129","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 166638 = Hospital System Supply Identifier | 147129 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-14","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407860","type":"LOCAL"},{"code":"206199","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407860 = Hospital System Supply Identifier | 206199 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-13","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407859","type":"LOCAL"},{"code":"206198","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407859 = Hospital System Supply Identifier | 206198 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-12","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407858","type":"LOCAL"},{"code":"206197","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407858 = Hospital System Supply Identifier | 206197 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-11","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407857","type":"LOCAL"},{"code":"206196","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407857 = Hospital System Supply Identifier | 206196 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-10","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407856","type":"LOCAL"},{"code":"206195","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407856 = Hospital System Supply Identifier | 206195 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-09","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407855","type":"LOCAL"},{"code":"206194","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407855 = Hospital System Supply Identifier | 206194 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-06","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407852","type":"LOCAL"},{"code":"206191","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407852 = Hospital System Supply Identifier | 206191 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-07","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407853","type":"LOCAL"},{"code":"206192","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407853 = Hospital System Supply Identifier | 206192 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-05","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407851","type":"LOCAL"},{"code":"206190","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407851 = Hospital System Supply Identifier | 206190 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-04","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407850","type":"LOCAL"},{"code":"206189","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407850 = Hospital System Supply Identifier | 206189 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-03","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407849","type":"LOCAL"},{"code":"206188","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407849 = Hospital System Supply Identifier | 206188 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-02","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407486","type":"LOCAL"},{"code":"147130","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407486 = Hospital System Supply Identifier | 147130 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-08","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407854","type":"LOCAL"},{"code":"206193","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407854 = Hospital System Supply Identifier | 206193 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY V 21.6CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408759","type":"LOCAL"},{"code":"339791","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408759 = Hospital System Supply Identifier | 339791 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY W 22.9CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408760","type":"LOCAL"},{"code":"339792","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408760 = Hospital System Supply Identifier | 339792 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY U 20.3CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408758","type":"LOCAL"},{"code":"339790","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408758 = Hospital System Supply Identifier | 339790 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Y 25.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408762","type":"LOCAL"},{"code":"339794","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408762 = Hospital System Supply Identifier | 339794 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY X 24.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408761","type":"LOCAL"},{"code":"339793","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408761 = Hospital System Supply Identifier | 339793 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY T 19.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408757","type":"LOCAL"},{"code":"339789","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408757 = Hospital System Supply Identifier | 339789 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Q 15.2CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408754","type":"LOCAL"},{"code":"339786","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408754 = Hospital System Supply Identifier | 339786 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY R 16.5CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408755","type":"LOCAL"},{"code":"339787","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408755 = Hospital System Supply Identifier | 339787 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY S 17.8CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408756","type":"LOCAL"},{"code":"339788","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408756 = Hospital System Supply Identifier | 339788 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY P 14.0CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408753","type":"LOCAL"},{"code":"339785","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408753 = Hospital System Supply Identifier | 339785 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY O 12.7CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408752","type":"LOCAL"},{"code":"339784","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408752 = Hospital System Supply Identifier | 339784 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY N 11.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408751","type":"LOCAL"},{"code":"339783","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.33,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408751 = Hospital System Supply Identifier | 339783 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053825","type":"LOCAL"},{"code":"876275","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053825 = Hospital System Supply Identifier | 876275 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053826","type":"LOCAL"},{"code":"876276","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053826 = Hospital System Supply Identifier | 876276 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053827","type":"LOCAL"},{"code":"876277","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053827 = Hospital System Supply Identifier | 876277 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053830","type":"LOCAL"},{"code":"876280","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053830 = Hospital System Supply Identifier | 876280 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053828","type":"LOCAL"},{"code":"876278","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053828 = Hospital System Supply Identifier | 876278 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053829","type":"LOCAL"},{"code":"876279","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053829 = Hospital System Supply Identifier | 876279 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18 CORT NON LOK","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821235","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821235 = Hospital System Supply Identifier"}]},{"description":"SCREW SLF-TP 3.5X12MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"918408","type":"LOCAL"},{"code":"711671","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 918408 = Hospital System Supply Identifier | 711671 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X14MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"832048","type":"LOCAL"},{"code":"711672","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 832048 = Hospital System Supply Identifier | 711672 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X16MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"832049","type":"LOCAL"},{"code":"711673","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 832049 = Hospital System Supply Identifier | 711673 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 10MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053831","type":"LOCAL"},{"code":"876281","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053831 = Hospital System Supply Identifier | 876281 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 28MM","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053832","type":"LOCAL"},{"code":"876282","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053832 = Hospital System Supply Identifier | 876282 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932149","type":"LOCAL"},{"code":"816524","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932149 = Hospital System Supply Identifier | 816524 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944916","type":"LOCAL"},{"code":"829511","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944916 = Hospital System Supply Identifier | 829511 = Lawson ID"}]},{"description":"SCREW BONE 3.5X24CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932147","type":"LOCAL"},{"code":"816522","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932147 = Hospital System Supply Identifier | 816522 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932148","type":"LOCAL"},{"code":"816523","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932148 = Hospital System Supply Identifier | 816523 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932146","type":"LOCAL"},{"code":"816521","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932146 = Hospital System Supply Identifier | 816521 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932150","type":"LOCAL"},{"code":"816525","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932150 = Hospital System Supply Identifier | 816525 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 30MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053833","type":"LOCAL"},{"code":"876283","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053833 = Hospital System Supply Identifier | 876283 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053834","type":"LOCAL"},{"code":"876284","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053834 = Hospital System Supply Identifier | 876284 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MMS HEX 35MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053835","type":"LOCAL"},{"code":"876285","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053835 = Hospital System Supply Identifier | 876285 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053836","type":"LOCAL"},{"code":"876286","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053836 = Hospital System Supply Identifier | 876286 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053838","type":"LOCAL"},{"code":"876288","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053838 = Hospital System Supply Identifier | 876288 = Lawson ID"}]},{"description":"SCREW BONE 3.5X46 CORT NON-LOK","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821257","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821257 = Hospital System Supply Identifier"}]},{"description":"SCREW S/T CORT 3.5MM HEX 40MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053837","type":"LOCAL"},{"code":"876287","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053837 = Hospital System Supply Identifier | 876287 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 44MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053839","type":"LOCAL"},{"code":"876289","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053839 = Hospital System Supply Identifier | 876289 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX, 45MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053840","type":"LOCAL"},{"code":"876290","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053840 = Hospital System Supply Identifier | 876290 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053841","type":"LOCAL"},{"code":"876291","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053841 = Hospital System Supply Identifier | 876291 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053844","type":"LOCAL"},{"code":"876294","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053844 = Hospital System Supply Identifier | 876294 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053843","type":"LOCAL"},{"code":"876293","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053843 = Hospital System Supply Identifier | 876293 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 58MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053845","type":"LOCAL"},{"code":"876295","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053845 = Hospital System Supply Identifier | 876295 = Lawson ID"}]},{"description":"SCREW BONE 3.5X55 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821259","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821259 = Hospital System Supply Identifier"}]},{"description":"SCREW BONE 3.5X50 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821258","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821258 = Hospital System Supply Identifier"}]},{"description":"SCREW S/T CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053842","type":"LOCAL"},{"code":"876292","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053842 = Hospital System Supply Identifier | 876292 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053847","type":"LOCAL"},{"code":"876297","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053847 = Hospital System Supply Identifier | 876297 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 60MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053846","type":"LOCAL"},{"code":"876296","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053846 = Hospital System Supply Identifier | 876296 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053848","type":"LOCAL"},{"code":"876298","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053848 = Hospital System Supply Identifier | 876298 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932142","type":"LOCAL"},{"code":"816517","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932142 = Hospital System Supply Identifier | 816517 = Lawson ID"}]},{"description":"SCREW BONE 3.5X16CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932144","type":"LOCAL"},{"code":"816519","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932144 = Hospital System Supply Identifier | 816519 = Lawson ID"}]},{"description":"SCREW BONE T15 103.5BLU NSTRL","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943269","type":"LOCAL"},{"code":"827838","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 943269 = Hospital System Supply Identifier | 827838 = Lawson ID"}]},{"description":"SCREW BONE 143.5NSTRL T15 HEXA","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943270","type":"LOCAL"},{"code":"827839","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 943270 = Hospital System Supply Identifier | 827839 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 12MM","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053849","type":"LOCAL"},{"code":"876299","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053849 = Hospital System Supply Identifier | 876299 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 24MM","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053850","type":"LOCAL"},{"code":"876300","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053850 = Hospital System Supply Identifier | 876300 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944914","type":"LOCAL"},{"code":"829509","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944914 = Hospital System Supply Identifier | 829509 = Lawson ID"}]},{"description":"SCREW BONE 3.5X28CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946351","type":"LOCAL"},{"code":"830987","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 946351 = Hospital System Supply Identifier | 830987 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932143","type":"LOCAL"},{"code":"816518","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932143 = Hospital System Supply Identifier | 816518 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932145","type":"LOCAL"},{"code":"816520","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932145 = Hospital System Supply Identifier | 816520 = Lawson ID"}]},{"description":"SCREW BONE 3.5X30CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944915","type":"LOCAL"},{"code":"829510","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944915 = Hospital System Supply Identifier | 829510 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944989","type":"LOCAL"},{"code":"829586","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944989 = Hospital System Supply Identifier | 829586 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946352","type":"LOCAL"},{"code":"830988","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 946352 = Hospital System Supply Identifier | 830988 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053851","type":"LOCAL"},{"code":"876301","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053851 = Hospital System Supply Identifier | 876301 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 35MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053852","type":"LOCAL"},{"code":"876302","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053852 = Hospital System Supply Identifier | 876302 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053853","type":"LOCAL"},{"code":"876303","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053853 = Hospital System Supply Identifier | 876303 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 46MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053856","type":"LOCAL"},{"code":"876306","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053856 = Hospital System Supply Identifier | 876306 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053857","type":"LOCAL"},{"code":"876307","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053857 = Hospital System Supply Identifier | 876307 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 45MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053855","type":"LOCAL"},{"code":"876305","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053855 = Hospital System Supply Identifier | 876305 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053854","type":"LOCAL"},{"code":"876304","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053854 = Hospital System Supply Identifier | 876304 = Lawson ID"}]},{"description":"SCREW BONE 3.5X44CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944991","type":"LOCAL"},{"code":"829588","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944991 = Hospital System Supply Identifier | 829588 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944990","type":"LOCAL"},{"code":"829587","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944990 = Hospital System Supply Identifier | 829587 = Lawson ID"}]},{"description":"SCREW BONE 3.5X50CORT LOCKING","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944992","type":"LOCAL"},{"code":"829589","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944992 = Hospital System Supply Identifier | 829589 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053858","type":"LOCAL"},{"code":"876308","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053858 = Hospital System Supply Identifier | 876308 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053859","type":"LOCAL"},{"code":"876309","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053859 = Hospital System Supply Identifier | 876309 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 50MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053860","type":"LOCAL"},{"code":"876310","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053860 = Hospital System Supply Identifier | 876310 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053861","type":"LOCAL"},{"code":"876311","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053861 = Hospital System Supply Identifier | 876311 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053862","type":"LOCAL"},{"code":"876312","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053862 = Hospital System Supply Identifier | 876312 = Lawson ID"}]},{"description":"SCREW BONE 3.5X60CORT LOCKING","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944993","type":"LOCAL"},{"code":"829590","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944993 = Hospital System Supply Identifier | 829590 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053863","type":"LOCAL"},{"code":"876313","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053863 = Hospital System Supply Identifier | 876313 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5LFT MEDIA","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932151","type":"LOCAL"},{"code":"816526","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932151 = Hospital System Supply Identifier | 816526 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053864","type":"LOCAL"},{"code":"876314","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053864 = Hospital System Supply Identifier | 876314 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053865","type":"LOCAL"},{"code":"876315","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053865 = Hospital System Supply Identifier | 876315 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053866","type":"LOCAL"},{"code":"876316","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053866 = Hospital System Supply Identifier | 876316 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053867","type":"LOCAL"},{"code":"876317","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053867 = Hospital System Supply Identifier | 876317 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053868","type":"LOCAL"},{"code":"876318","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053868 = Hospital System Supply Identifier | 876318 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053871","type":"LOCAL"},{"code":"876321","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053871 = Hospital System Supply Identifier | 876321 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053870","type":"LOCAL"},{"code":"876320","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053870 = Hospital System Supply Identifier | 876320 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053872","type":"LOCAL"},{"code":"876322","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053872 = Hospital System Supply Identifier | 876322 = Lawson ID"}]},{"description":"PLATE BONE NARROW 136NSTRL 8H","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943268","type":"LOCAL"},{"code":"827837","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 943268 = Hospital System Supply Identifier | 827837 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053869","type":"LOCAL"},{"code":"876319","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053869 = Hospital System Supply Identifier | 876319 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5RT MEDIAL","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932141","type":"LOCAL"},{"code":"816516","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932141 = Hospital System Supply Identifier | 816516 = Lawson ID"}]},{"description":"PLATE LT 4H 3.5WIDE MEDIAL DIS","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946353","type":"LOCAL"},{"code":"830989","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 946353 = Hospital System Supply Identifier | 830989 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053873","type":"LOCAL"},{"code":"876323","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053873 = Hospital System Supply Identifier | 876323 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053874","type":"LOCAL"},{"code":"876324","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053874 = Hospital System Supply Identifier | 876324 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053875","type":"LOCAL"},{"code":"876325","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053875 = Hospital System Supply Identifier | 876325 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053876","type":"LOCAL"},{"code":"876326","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053876 = Hospital System Supply Identifier | 876326 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053877","type":"LOCAL"},{"code":"876327","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053877 = Hospital System Supply Identifier | 876327 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053883","type":"LOCAL"},{"code":"876333","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053883 = Hospital System Supply Identifier | 876333 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053882","type":"LOCAL"},{"code":"876332","type":"LOCAL"}],"standard_charges":[{"gross_charge":9742.78,"discounted_cash":7307.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053882 = Hospital System Supply Identifier | 876332 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053881","type":"LOCAL"},{"code":"876331","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053881 = Hospital System Supply Identifier | 876331 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053879","type":"LOCAL"},{"code":"876329","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053879 = Hospital System Supply Identifier | 876329 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053878","type":"LOCAL"},{"code":"876328","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053878 = Hospital System Supply Identifier | 876328 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 4H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053880","type":"LOCAL"},{"code":"876330","type":"LOCAL"}],"standard_charges":[{"gross_charge":6468.57,"discounted_cash":4851.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053880 = Hospital System Supply Identifier | 876330 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053884","type":"LOCAL"},{"code":"876334","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053884 = Hospital System Supply Identifier | 876334 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053885","type":"LOCAL"},{"code":"876335","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053885 = Hospital System Supply Identifier | 876335 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053886","type":"LOCAL"},{"code":"876336","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053886 = Hospital System Supply Identifier | 876336 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053887","type":"LOCAL"},{"code":"876337","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053887 = Hospital System Supply Identifier | 876337 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053888","type":"LOCAL"},{"code":"876338","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053888 = Hospital System Supply Identifier | 876338 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053892","type":"LOCAL"},{"code":"876342","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053892 = Hospital System Supply Identifier | 876342 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053893","type":"LOCAL"},{"code":"876343","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053893 = Hospital System Supply Identifier | 876343 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053891","type":"LOCAL"},{"code":"876341","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053891 = Hospital System Supply Identifier | 876341 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053890","type":"LOCAL"},{"code":"876340","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053890 = Hospital System Supply Identifier | 876340 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053889","type":"LOCAL"},{"code":"876339","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053889 = Hospital System Supply Identifier | 876339 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053894","type":"LOCAL"},{"code":"876344","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053894 = Hospital System Supply Identifier | 876344 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053895","type":"LOCAL"},{"code":"876345","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053895 = Hospital System Supply Identifier | 876345 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053896","type":"LOCAL"},{"code":"876346","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053896 = Hospital System Supply Identifier | 876346 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053897","type":"LOCAL"},{"code":"876347","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053897 = Hospital System Supply Identifier | 876347 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053898","type":"LOCAL"},{"code":"876348","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053898 = Hospital System Supply Identifier | 876348 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 10MM","code_information":[{"code":"Sx00-0903-387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053899","type":"LOCAL"},{"code":"876349","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053899 = Hospital System Supply Identifier | 876349 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053904","type":"LOCAL"},{"code":"876354","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053904 = Hospital System Supply Identifier | 876354 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053903","type":"LOCAL"},{"code":"876353","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053903 = Hospital System Supply Identifier | 876353 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053902","type":"LOCAL"},{"code":"876352","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053902 = Hospital System Supply Identifier | 876352 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053901","type":"LOCAL"},{"code":"876351","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053901 = Hospital System Supply Identifier | 876351 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053900","type":"LOCAL"},{"code":"876350","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053900 = Hospital System Supply Identifier | 876350 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053905","type":"LOCAL"},{"code":"876355","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053905 = Hospital System Supply Identifier | 876355 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053906","type":"LOCAL"},{"code":"876356","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053906 = Hospital System Supply Identifier | 876356 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053907","type":"LOCAL"},{"code":"876357","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053907 = Hospital System Supply Identifier | 876357 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053908","type":"LOCAL"},{"code":"876358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053908 = Hospital System Supply Identifier | 876358 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053909","type":"LOCAL"},{"code":"876359","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053909 = Hospital System Supply Identifier | 876359 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053913","type":"LOCAL"},{"code":"876363","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053913 = Hospital System Supply Identifier | 876363 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053914","type":"LOCAL"},{"code":"876364","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053914 = Hospital System Supply Identifier | 876364 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053911","type":"LOCAL"},{"code":"876361","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053911 = Hospital System Supply Identifier | 876361 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053910","type":"LOCAL"},{"code":"876360","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053910 = Hospital System Supply Identifier | 876360 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053912","type":"LOCAL"},{"code":"876362","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053912 = Hospital System Supply Identifier | 876362 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 15MM","code_information":[{"code":"Sx00-0903-397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053915","type":"LOCAL"},{"code":"876365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":2085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053915 = Hospital System Supply Identifier | 876365 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036103 3.5MM","code_information":[{"code":"Sx00-0903-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356466","type":"LOCAL"},{"code":"1082536","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356466 = Hospital System Supply Identifier | 1082536 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036203 3.5MM","code_information":[{"code":"Sx00-0903-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356350","type":"LOCAL"},{"code":"1082496","type":"LOCAL"}],"standard_charges":[{"gross_charge":7054.7,"discounted_cash":5291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356350 = Hospital System Supply Identifier | 1082496 = Lawson ID"}]},{"description":"PLATE INF 90D 3HL","code_information":[{"code":"Sx00-0907-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053916","type":"LOCAL"},{"code":"876366","type":"LOCAL"}],"standard_charges":[{"gross_charge":6028.0,"discounted_cash":4521.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053916 = Hospital System Supply Identifier | 876366 = Lawson ID"}]},{"description":"PLATE INF 110D 3HL","code_information":[{"code":"Sx00-0907-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053917","type":"LOCAL"},{"code":"876367","type":"LOCAL"}],"standard_charges":[{"gross_charge":6028.0,"discounted_cash":4521.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053917 = Hospital System Supply Identifier | 876367 = Lawson ID"}]},{"description":"PLATE INF 130D 3HL","code_information":[{"code":"Sx00-0907-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053918","type":"LOCAL"},{"code":"876368","type":"LOCAL"}],"standard_charges":[{"gross_charge":6028.0,"discounted_cash":4521.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053918 = Hospital System Supply Identifier | 876368 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053919","type":"LOCAL"},{"code":"876369","type":"LOCAL"}],"standard_charges":[{"gross_charge":5958.26,"discounted_cash":4468.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053919 = Hospital System Supply Identifier | 876369 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053920","type":"LOCAL"},{"code":"876370","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053920 = Hospital System Supply Identifier | 876370 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 6OFFSET","code_information":[{"code":"Sx00-0907-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944994","type":"LOCAL"},{"code":"829591","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944994 = Hospital System Supply Identifier | 829591 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053921","type":"LOCAL"},{"code":"876371","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053921 = Hospital System Supply Identifier | 876371 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053922","type":"LOCAL"},{"code":"876372","type":"LOCAL"}],"standard_charges":[{"gross_charge":6148.14,"discounted_cash":4611.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053922 = Hospital System Supply Identifier | 876372 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053923","type":"LOCAL"},{"code":"876373","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053923 = Hospital System Supply Identifier | 876373 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 12OFFSET","code_information":[{"code":"Sx00-0907-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944995","type":"LOCAL"},{"code":"829592","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944995 = Hospital System Supply Identifier | 829592 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053924","type":"LOCAL"},{"code":"876374","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053924 = Hospital System Supply Identifier | 876374 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053925","type":"LOCAL"},{"code":"876375","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053925 = Hospital System Supply Identifier | 876375 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053926","type":"LOCAL"},{"code":"876376","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053926 = Hospital System Supply Identifier | 876376 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053927","type":"LOCAL"},{"code":"876377","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053927 = Hospital System Supply Identifier | 876377 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053928","type":"LOCAL"},{"code":"876378","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053928 = Hospital System Supply Identifier | 876378 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053929","type":"LOCAL"},{"code":"876379","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053929 = Hospital System Supply Identifier | 876379 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 3HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053930","type":"LOCAL"},{"code":"876380","type":"LOCAL"}],"standard_charges":[{"gross_charge":6243.23,"discounted_cash":4682.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053930 = Hospital System Supply Identifier | 876380 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053931","type":"LOCAL"},{"code":"876381","type":"LOCAL"}],"standard_charges":[{"gross_charge":6243.23,"discounted_cash":4682.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053931 = Hospital System Supply Identifier | 876381 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053932","type":"LOCAL"},{"code":"876382","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053932 = Hospital System Supply Identifier | 876382 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053933","type":"LOCAL"},{"code":"876383","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053933 = Hospital System Supply Identifier | 876383 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053934","type":"LOCAL"},{"code":"876384","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053934 = Hospital System Supply Identifier | 876384 = Lawson ID"}]},{"description":"PLATE BONE 3.5 130-DEG 6-HOLE","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"818909","type":"LOCAL"}],"standard_charges":[{"gross_charge":6842.97,"discounted_cash":5132.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 818909 = Hospital System Supply Identifier"}]},{"description":"PLATE BONE 130 DEG 784H SS","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945776","type":"LOCAL"},{"code":"830396","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 945776 = Hospital System Supply Identifier | 830396 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053935","type":"LOCAL"},{"code":"876385","type":"LOCAL"}],"standard_charges":[{"gross_charge":6495.48,"discounted_cash":4871.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053935 = Hospital System Supply Identifier | 876385 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 8HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053936","type":"LOCAL"},{"code":"876386","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053936 = Hospital System Supply Identifier | 876386 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 10HL","code_information":[{"code":"Sx00-0907-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053937","type":"LOCAL"},{"code":"876387","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053937 = Hospital System Supply Identifier | 876387 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 6HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053939","type":"LOCAL"},{"code":"876389","type":"LOCAL"}],"standard_charges":[{"gross_charge":6409.49,"discounted_cash":4807.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053939 = Hospital System Supply Identifier | 876389 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 3HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053938","type":"LOCAL"},{"code":"876388","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053938 = Hospital System Supply Identifier | 876388 = Lawson ID"}]},{"description":"PLATE BONE FX 4.5 130-DEG 4-HO","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"819260","type":"LOCAL"}],"standard_charges":[{"gross_charge":6243.23,"discounted_cash":4682.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 819260 = Hospital System Supply Identifier"}]},{"description":"PLATE BONE 130 D FEM PROX 8H L","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939584","type":"LOCAL"},{"code":"824109","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939584 = Hospital System Supply Identifier | 824109 = Lawson ID"}]},{"description":"PLATE 103DX4.5MM 10HL","code_information":[{"code":"Sx00-0907-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053940","type":"LOCAL"},{"code":"876390","type":"LOCAL"}],"standard_charges":[{"gross_charge":9792.09,"discounted_cash":7344.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053940 = Hospital System Supply Identifier | 876390 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053941","type":"LOCAL"},{"code":"876391","type":"LOCAL"}],"standard_charges":[{"gross_charge":6495.48,"discounted_cash":4871.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053941 = Hospital System Supply Identifier | 876391 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 5HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053942","type":"LOCAL"},{"code":"876392","type":"LOCAL"}],"standard_charges":[{"gross_charge":6681.81,"discounted_cash":5011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053942 = Hospital System Supply Identifier | 876392 = Lawson ID"}]},{"description":"PLATE 150DX4.5 3HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053943","type":"LOCAL"},{"code":"876393","type":"LOCAL"}],"standard_charges":[{"gross_charge":5926.62,"discounted_cash":4444.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053943 = Hospital System Supply Identifier | 876393 = Lawson ID"}]},{"description":"PLATE 150DX4.5 5HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053944","type":"LOCAL"},{"code":"876394","type":"LOCAL"}],"standard_charges":[{"gross_charge":6096.36,"discounted_cash":4572.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053944 = Hospital System Supply Identifier | 876394 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X38MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053948","type":"LOCAL"},{"code":"876398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053948 = Hospital System Supply Identifier | 876398 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X34MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053947","type":"LOCAL"},{"code":"876397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053947 = Hospital System Supply Identifier | 876397 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X30MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053945","type":"LOCAL"},{"code":"876395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053945 = Hospital System Supply Identifier | 876395 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X32MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053946","type":"LOCAL"},{"code":"876396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053946 = Hospital System Supply Identifier | 876396 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CANN LOCKING","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945774","type":"LOCAL"},{"code":"830394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 945774 = Hospital System Supply Identifier | 830394 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CANN LOCKING","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945775","type":"LOCAL"},{"code":"830395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 945775 = Hospital System Supply Identifier | 830395 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X45MM","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053949","type":"LOCAL"},{"code":"876399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053949 = Hospital System Supply Identifier | 876399 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X50MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053950","type":"LOCAL"},{"code":"876400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053950 = Hospital System Supply Identifier | 876400 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X55MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053951","type":"LOCAL"},{"code":"876401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053951 = Hospital System Supply Identifier | 876401 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X60MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053952","type":"LOCAL"},{"code":"876402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053952 = Hospital System Supply Identifier | 876402 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X65MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053953","type":"LOCAL"},{"code":"876403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053953 = Hospital System Supply Identifier | 876403 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X70MM","code_information":[{"code":"Sx00-0907-377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053954","type":"LOCAL"},{"code":"876404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.68,"discounted_cash":1226.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053954 = Hospital System Supply Identifier | 876404 = Lawson ID"}]},{"description":"PLATE 140DX3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053955","type":"LOCAL"},{"code":"876405","type":"LOCAL"}],"standard_charges":[{"gross_charge":6974.08,"discounted_cash":5230.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053955 = Hospital System Supply Identifier | 876405 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074103 3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356942","type":"LOCAL"},{"code":"1082505","type":"LOCAL"}],"standard_charges":[{"gross_charge":6601.14,"discounted_cash":4950.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356942 = Hospital System Supply Identifier | 1082505 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074203 4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356944","type":"LOCAL"},{"code":"1082555","type":"LOCAL"}],"standard_charges":[{"gross_charge":6601.14,"discounted_cash":4950.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356944 = Hospital System Supply Identifier | 1082555 = Lawson ID"}]},{"description":"PLATE 140DX4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053956","type":"LOCAL"},{"code":"876406","type":"LOCAL"}],"standard_charges":[{"gross_charge":6541.08,"discounted_cash":4905.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053956 = Hospital System Supply Identifier | 876406 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X10MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053957","type":"LOCAL"},{"code":"876407","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053957 = Hospital System Supply Identifier | 876407 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X12MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053958","type":"LOCAL"},{"code":"876408","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053958 = Hospital System Supply Identifier | 876408 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X14MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053959","type":"LOCAL"},{"code":"876409","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053959 = Hospital System Supply Identifier | 876409 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X16MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053960","type":"LOCAL"},{"code":"876410","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053960 = Hospital System Supply Identifier | 876410 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X18MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053961","type":"LOCAL"},{"code":"876411","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053961 = Hospital System Supply Identifier | 876411 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X26MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053962","type":"LOCAL"},{"code":"876412","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053962 = Hospital System Supply Identifier | 876412 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X28MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053963","type":"LOCAL"},{"code":"876413","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053963 = Hospital System Supply Identifier | 876413 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 SLF-TP CORT","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971157","type":"LOCAL"},{"code":"841869","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971157 = Hospital System Supply Identifier | 841869 = Lawson ID"}]},{"description":"SCREW BONE 4.5X22 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821596","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821596 = Hospital System Supply Identifier"}]},{"description":"SCREW BONE 4.5X20 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821595","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821595 = Hospital System Supply Identifier"}]},{"description":"SCREW BONE 384.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939587","type":"LOCAL"},{"code":"824112","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939587 = Hospital System Supply Identifier | 824112 = Lawson ID"}]},{"description":"SCREW BONE 364.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939588","type":"LOCAL"},{"code":"824113","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939588 = Hospital System Supply Identifier | 824113 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X30MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053964","type":"LOCAL"},{"code":"876414","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053964 = Hospital System Supply Identifier | 876414 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X32MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053965","type":"LOCAL"},{"code":"876415","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053965 = Hospital System Supply Identifier | 876415 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X34MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053966","type":"LOCAL"},{"code":"876416","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053966 = Hospital System Supply Identifier | 876416 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X48MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053971","type":"LOCAL"},{"code":"876421","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053971 = Hospital System Supply Identifier | 876421 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X46MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053970","type":"LOCAL"},{"code":"876420","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053970 = Hospital System Supply Identifier | 876420 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X44MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053969","type":"LOCAL"},{"code":"876419","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053969 = Hospital System Supply Identifier | 876419 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X42MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053968","type":"LOCAL"},{"code":"876418","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053968 = Hospital System Supply Identifier | 876418 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X40MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053967","type":"LOCAL"},{"code":"876417","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053967 = Hospital System Supply Identifier | 876417 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X50MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053972","type":"LOCAL"},{"code":"876422","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053972 = Hospital System Supply Identifier | 876422 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X55MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053973","type":"LOCAL"},{"code":"876423","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053973 = Hospital System Supply Identifier | 876423 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X60MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053974","type":"LOCAL"},{"code":"876424","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053974 = Hospital System Supply Identifier | 876424 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X65MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053975","type":"LOCAL"},{"code":"876425","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053975 = Hospital System Supply Identifier | 876425 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X70MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053976","type":"LOCAL"},{"code":"876426","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053976 = Hospital System Supply Identifier | 876426 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X75MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053977","type":"LOCAL"},{"code":"876427","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053977 = Hospital System Supply Identifier | 876427 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X80MM","code_information":[{"code":"Sx00-0907-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053978","type":"LOCAL"},{"code":"876428","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053978 = Hospital System Supply Identifier | 876428 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X18","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053983","type":"LOCAL"},{"code":"876433","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053983 = Hospital System Supply Identifier | 876433 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X16","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053982","type":"LOCAL"},{"code":"876432","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053982 = Hospital System Supply Identifier | 876432 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X10","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053979","type":"LOCAL"},{"code":"876429","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053979 = Hospital System Supply Identifier | 876429 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X12","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053980","type":"LOCAL"},{"code":"876430","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053980 = Hospital System Supply Identifier | 876430 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X14","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053981","type":"LOCAL"},{"code":"876431","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053981 = Hospital System Supply Identifier | 876431 = Lawson ID"}]},{"description":"SCREW BONE 20X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971155","type":"LOCAL"},{"code":"841867","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971155 = Hospital System Supply Identifier | 841867 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971156","type":"LOCAL"},{"code":"841868","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971156 = Hospital System Supply Identifier | 841868 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X22","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053984","type":"LOCAL"},{"code":"876434","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053984 = Hospital System Supply Identifier | 876434 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X26","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053985","type":"LOCAL"},{"code":"876435","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053985 = Hospital System Supply Identifier | 876435 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X28","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053986","type":"LOCAL"},{"code":"876436","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053986 = Hospital System Supply Identifier | 876436 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X30","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053987","type":"LOCAL"},{"code":"876437","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053987 = Hospital System Supply Identifier | 876437 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X32","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053988","type":"LOCAL"},{"code":"876438","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053988 = Hospital System Supply Identifier | 876438 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X34","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053989","type":"LOCAL"},{"code":"876439","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053989 = Hospital System Supply Identifier | 876439 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X36","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053990","type":"LOCAL"},{"code":"876440","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053990 = Hospital System Supply Identifier | 876440 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X38","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053991","type":"LOCAL"},{"code":"876441","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053991 = Hospital System Supply Identifier | 876441 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X45","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053994","type":"LOCAL"},{"code":"876444","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053994 = Hospital System Supply Identifier | 876444 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X44","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053993","type":"LOCAL"},{"code":"876443","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053993 = Hospital System Supply Identifier | 876443 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X48","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053995","type":"LOCAL"},{"code":"876445","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053995 = Hospital System Supply Identifier | 876445 = Lawson ID"}]},{"description":"SCREW BONE 46X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971159","type":"LOCAL"},{"code":"841871","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971159 = Hospital System Supply Identifier | 841871 = Lawson ID"}]},{"description":"SCREW BONE 42X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971158","type":"LOCAL"},{"code":"841870","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971158 = Hospital System Supply Identifier | 841870 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X40","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053992","type":"LOCAL"},{"code":"876442","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053992 = Hospital System Supply Identifier | 876442 = Lawson ID"}]},{"description":"SCREW BONE 50X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971160","type":"LOCAL"},{"code":"841872","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971160 = Hospital System Supply Identifier | 841872 = Lawson ID"}]},{"description":"SCREW BONE 55X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971161","type":"LOCAL"},{"code":"841873","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971161 = Hospital System Supply Identifier | 841873 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X60","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053996","type":"LOCAL"},{"code":"876446","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053996 = Hospital System Supply Identifier | 876446 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X65","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053997","type":"LOCAL"},{"code":"876447","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053997 = Hospital System Supply Identifier | 876447 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X70","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053998","type":"LOCAL"},{"code":"876448","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053998 = Hospital System Supply Identifier | 876448 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X75","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053999","type":"LOCAL"},{"code":"876449","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1053999 = Hospital System Supply Identifier | 876449 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X80","code_information":[{"code":"Sx00-0907-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054000","type":"LOCAL"},{"code":"876450","type":"LOCAL"}],"standard_charges":[{"gross_charge":811.47,"discounted_cash":608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054000 = Hospital System Supply Identifier | 876450 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X38MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054005","type":"LOCAL"},{"code":"876455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054005 = Hospital System Supply Identifier | 876455 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X36MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054004","type":"LOCAL"},{"code":"876454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054004 = Hospital System Supply Identifier | 876454 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X30MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054001","type":"LOCAL"},{"code":"876451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054001 = Hospital System Supply Identifier | 876451 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X32MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054002","type":"LOCAL"},{"code":"876452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054002 = Hospital System Supply Identifier | 876452 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X34MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054003","type":"LOCAL"},{"code":"876453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054003 = Hospital System Supply Identifier | 876453 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X40MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054006","type":"LOCAL"},{"code":"876456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054006 = Hospital System Supply Identifier | 876456 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X45MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054007","type":"LOCAL"},{"code":"876457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054007 = Hospital System Supply Identifier | 876457 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X50MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054008","type":"LOCAL"},{"code":"876458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054008 = Hospital System Supply Identifier | 876458 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X55MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054009","type":"LOCAL"},{"code":"876459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054009 = Hospital System Supply Identifier | 876459 = Lawson ID"}]},{"description":"SCREW BONE 654.5PROX FEM T20 H","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939586","type":"LOCAL"},{"code":"824111","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939586 = Hospital System Supply Identifier | 824111 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X60MM","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054010","type":"LOCAL"},{"code":"876460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054010 = Hospital System Supply Identifier | 876460 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X75MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054012","type":"LOCAL"},{"code":"876462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054012 = Hospital System Supply Identifier | 876462 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X70MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054011","type":"LOCAL"},{"code":"876461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054011 = Hospital System Supply Identifier | 876461 = Lawson ID"}]},{"description":"SCREW BONE 804.5HEXALOBE FEM P","code_information":[{"code":"Sx00-0907-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939585","type":"LOCAL"},{"code":"824110","type":"LOCAL"}],"standard_charges":[{"gross_charge":1525.26,"discounted_cash":1143.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939585 = Hospital System Supply Identifier | 824110 = Lawson ID"}]},{"description":"DISC - GWIRE RM MDLLRY4.7X68","code_information":[{"code":"Sx00-0928-039","type":"CDM"},{"code":"272","type":"RC"},{"code":"408388","type":"LOCAL"},{"code":"310986","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408388 = Hospital System Supply Identifier | 310986 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-100-63-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779931","type":"LOCAL"},{"code":"773376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1133.21,"discounted_cash":849.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 779931 = Hospital System Supply Identifier | 773376 = Lawson ID"}]},{"description":"NAIL FLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054013","type":"LOCAL"},{"code":"876463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054013 = Hospital System Supply Identifier | 876463 = Lawson ID"}]},{"description":"NAIL FLEX TI 2.0MM","code_information":[{"code":"Sx00-1000-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054014","type":"LOCAL"},{"code":"876464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054014 = Hospital System Supply Identifier | 876464 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 2.5TI FLEX","code_information":[{"code":"Sx00-1000-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932137","type":"LOCAL"},{"code":"816512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 932137 = Hospital System Supply Identifier | 816512 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.0MM","code_information":[{"code":"Sx00-1000-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054015","type":"LOCAL"},{"code":"876465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054015 = Hospital System Supply Identifier | 876465 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054016","type":"LOCAL"},{"code":"876466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054016 = Hospital System Supply Identifier | 876466 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.0MM","code_information":[{"code":"Sx00-1000-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054017","type":"LOCAL"},{"code":"876467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054017 = Hospital System Supply Identifier | 876467 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054018","type":"LOCAL"},{"code":"876468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054018 = Hospital System Supply Identifier | 876468 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2MM","code_information":[{"code":"Sx00-1000-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881051","type":"LOCAL"},{"code":"401794","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 881051 = Hospital System Supply Identifier | 401794 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2.5MM","code_information":[{"code":"Sx00-1000-125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881052","type":"LOCAL"},{"code":"401795","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 881052 = Hospital System Supply Identifier | 401795 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3MM","code_information":[{"code":"Sx00-1000-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881053","type":"LOCAL"},{"code":"401796","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 881053 = Hospital System Supply Identifier | 401796 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3.5MM","code_information":[{"code":"Sx00-1000-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050783","type":"LOCAL"},{"code":"401797","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050783 = Hospital System Supply Identifier | 401797 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4MM","code_information":[{"code":"Sx00-1000-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050784","type":"LOCAL"},{"code":"401798","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050784 = Hospital System Supply Identifier | 401798 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4.5MM","code_information":[{"code":"Sx00-1000-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050785","type":"LOCAL"},{"code":"401799","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.41,"discounted_cash":445.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050785 = Hospital System Supply Identifier | 401799 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 1.5MM","code_information":[{"code":"Sx00-1000-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"817980","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 817980 = Hospital System Supply Identifier"}]},{"description":"NAIL PEDFLEX SS 2MM","code_information":[{"code":"Sx00-1000-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050786","type":"LOCAL"},{"code":"401801","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050786 = Hospital System Supply Identifier | 401801 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5MM","code_information":[{"code":"Sx00-1000-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"817981","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 817981 = Hospital System Supply Identifier"}]},{"description":"NAIL PEDFLEX SS 3MM","code_information":[{"code":"Sx00-1000-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050787","type":"LOCAL"},{"code":"401803","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050787 = Hospital System Supply Identifier | 401803 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5MM","code_information":[{"code":"Sx00-1000-335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050788","type":"LOCAL"},{"code":"401804","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050788 = Hospital System Supply Identifier | 401804 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4MM","code_information":[{"code":"Sx00-1000-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050789","type":"LOCAL"},{"code":"401805","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050789 = Hospital System Supply Identifier | 401805 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881047","type":"LOCAL"},{"code":"401787","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 881047 = Hospital System Supply Identifier | 401787 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2MM","code_information":[{"code":"Sx00-1000-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881048","type":"LOCAL"},{"code":"401788","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 881048 = Hospital System Supply Identifier | 401788 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2.5MM","code_information":[{"code":"Sx00-1000-525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881049","type":"LOCAL"},{"code":"401789","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 881049 = Hospital System Supply Identifier | 401789 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3MM","code_information":[{"code":"Sx00-1000-530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881050","type":"LOCAL"},{"code":"401790","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 881050 = Hospital System Supply Identifier | 401790 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050780","type":"LOCAL"},{"code":"401791","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050780 = Hospital System Supply Identifier | 401791 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4MM","code_information":[{"code":"Sx00-1000-540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050781","type":"LOCAL"},{"code":"401792","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050781 = Hospital System Supply Identifier | 401792 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050782","type":"LOCAL"},{"code":"401793","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050782 = Hospital System Supply Identifier | 401793 = Lawson ID"}]},{"description":"NAIL FLEX SS RND TIP 1.5X300MM","code_information":[{"code":"Sx00-1000-615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886407","type":"LOCAL"},{"code":"454543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 886407 = Hospital System Supply Identifier | 454543 = Lawson ID"}]},{"description":"NAIL PEDIFLEX RND TIP SS 2.0MM","code_information":[{"code":"Sx00-1000-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886242","type":"LOCAL"},{"code":"449446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 886242 = Hospital System Supply Identifier | 449446 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5X300MM","code_information":[{"code":"Sx00-1000-625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886717","type":"LOCAL"},{"code":"455417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 886717 = Hospital System Supply Identifier | 455417 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.0X400MM","code_information":[{"code":"Sx00-1000-630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051021","type":"LOCAL"},{"code":"455418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1051021 = Hospital System Supply Identifier | 455418 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5X400MM","code_information":[{"code":"Sx00-1000-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051022","type":"LOCAL"},{"code":"455419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1051022 = Hospital System Supply Identifier | 455419 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4.0X450MM","code_information":[{"code":"Sx00-1000-640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051023","type":"LOCAL"},{"code":"455420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1453.3,"discounted_cash":1089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1051023 = Hospital System Supply Identifier | 455420 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 1.5X300","code_information":[{"code":"Sx00-1001-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054019","type":"LOCAL"},{"code":"876469","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054019 = Hospital System Supply Identifier | 876469 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.0X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054020","type":"LOCAL"},{"code":"876470","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054020 = Hospital System Supply Identifier | 876470 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.5X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054021","type":"LOCAL"},{"code":"876471","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054021 = Hospital System Supply Identifier | 876471 = Lawson ID"}]},{"description":"NAIL TI 3.0MMX400FLEX","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942921","type":"LOCAL"},{"code":"827479","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 942921 = Hospital System Supply Identifier | 827479 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 3.5X400","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054022","type":"LOCAL"},{"code":"876472","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054022 = Hospital System Supply Identifier | 876472 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 4.0X450","code_information":[{"code":"Sx00-1001-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054023","type":"LOCAL"},{"code":"876473","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054023 = Hospital System Supply Identifier | 876473 = Lawson ID"}]},{"description":"NAIL TI FLEX 1.5MMX300MM","code_information":[{"code":"Sx00-1001-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943005","type":"LOCAL"},{"code":"827565","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 943005 = Hospital System Supply Identifier | 827565 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.5MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942911","type":"LOCAL"},{"code":"827469","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 942911 = Hospital System Supply Identifier | 827469 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.0MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942912","type":"LOCAL"},{"code":"827470","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 942912 = Hospital System Supply Identifier | 827470 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 4003.5ELAS","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944599","type":"LOCAL"},{"code":"829177","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944599 = Hospital System Supply Identifier | 829177 = Lawson ID"}]},{"description":"NAIL TI FLEX 3.0MMX400ROUND TI","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944793","type":"LOCAL"},{"code":"829382","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 944793 = Hospital System Supply Identifier | 829382 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.0X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054024","type":"LOCAL"},{"code":"876474","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054024 = Hospital System Supply Identifier | 876474 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.5X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054025","type":"LOCAL"},{"code":"876475","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054025 = Hospital System Supply Identifier | 876475 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356827","type":"LOCAL"},{"code":"1083729","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356827 = Hospital System Supply Identifier | 1083729 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356434","type":"LOCAL"},{"code":"1083742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356434 = Hospital System Supply Identifier | 1083742 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356498","type":"LOCAL"},{"code":"1083545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356498 = Hospital System Supply Identifier | 1083545 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356384","type":"LOCAL"},{"code":"1083589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356384 = Hospital System Supply Identifier | 1083589 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356394","type":"LOCAL"},{"code":"1083558","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356394 = Hospital System Supply Identifier | 1083558 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356352","type":"LOCAL"},{"code":"1083620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2338.02,"discounted_cash":1753.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356352 = Hospital System Supply Identifier | 1083620 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356970","type":"LOCAL"},{"code":"1083593","type":"LOCAL"}],"standard_charges":[{"gross_charge":684.86,"discounted_cash":513.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356970 = Hospital System Supply Identifier | 1083593 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356625","type":"LOCAL"},{"code":"1083599","type":"LOCAL"}],"standard_charges":[{"gross_charge":684.86,"discounted_cash":513.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356625 = Hospital System Supply Identifier | 1083599 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356949","type":"LOCAL"},{"code":"1083628","type":"LOCAL"}],"standard_charges":[{"gross_charge":684.86,"discounted_cash":513.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356949 = Hospital System Supply Identifier | 1083628 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357118","type":"LOCAL"},{"code":"1083559","type":"LOCAL"}],"standard_charges":[{"gross_charge":724.48,"discounted_cash":543.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357118 = Hospital System Supply Identifier | 1083559 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356385","type":"LOCAL"},{"code":"1083659","type":"LOCAL"}],"standard_charges":[{"gross_charge":724.48,"discounted_cash":543.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356385 = Hospital System Supply Identifier | 1083659 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356751","type":"LOCAL"},{"code":"1083689","type":"LOCAL"}],"standard_charges":[{"gross_charge":724.48,"discounted_cash":543.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356751 = Hospital System Supply Identifier | 1083689 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356433","type":"LOCAL"},{"code":"1083733","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356433 = Hospital System Supply Identifier | 1083733 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356951","type":"LOCAL"},{"code":"1083716","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356951 = Hospital System Supply Identifier | 1083716 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356837","type":"LOCAL"},{"code":"1083710","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356837 = Hospital System Supply Identifier | 1083710 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357128","type":"LOCAL"},{"code":"1083616","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357128 = Hospital System Supply Identifier | 1083616 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356363","type":"LOCAL"},{"code":"1083635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356363 = Hospital System Supply Identifier | 1083635 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356369","type":"LOCAL"},{"code":"1083707","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356369 = Hospital System Supply Identifier | 1083707 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357071","type":"LOCAL"},{"code":"1083723","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357071 = Hospital System Supply Identifier | 1083723 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356460","type":"LOCAL"},{"code":"1083736","type":"LOCAL"}],"standard_charges":[{"gross_charge":2457.99,"discounted_cash":1843.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356460 = Hospital System Supply Identifier | 1083736 = Lawson ID"}]},{"description":"GUIDE WIRE 1.6MMX150SMOOTH","code_information":[{"code":"Sx00-1005-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"942666","type":"LOCAL"},{"code":"827218","type":"LOCAL"}],"standard_charges":[{"gross_charge":111.51,"discounted_cash":83.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 942666 = Hospital System Supply Identifier | 827218 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 8HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054030","type":"LOCAL"},{"code":"876480","type":"LOCAL"}],"standard_charges":[{"gross_charge":814.81,"discounted_cash":611.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054030 = Hospital System Supply Identifier | 876480 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 7HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054029","type":"LOCAL"},{"code":"876479","type":"LOCAL"}],"standard_charges":[{"gross_charge":814.81,"discounted_cash":611.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054029 = Hospital System Supply Identifier | 876479 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 4HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054027","type":"LOCAL"},{"code":"876477","type":"LOCAL"}],"standard_charges":[{"gross_charge":741.34,"discounted_cash":556.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054027 = Hospital System Supply Identifier | 876477 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 6HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054028","type":"LOCAL"},{"code":"876478","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.08,"discounted_cash":583.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054028 = Hospital System Supply Identifier | 876478 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 10HL","code_information":[{"code":"Sx00-1005-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054031","type":"LOCAL"},{"code":"876481","type":"LOCAL"}],"standard_charges":[{"gross_charge":879.42,"discounted_cash":659.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054031 = Hospital System Supply Identifier | 876481 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 4HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054032","type":"LOCAL"},{"code":"876482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1936.14,"discounted_cash":1452.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054032 = Hospital System Supply Identifier | 876482 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 5HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054033","type":"LOCAL"},{"code":"876483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1972.48,"discounted_cash":1479.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054033 = Hospital System Supply Identifier | 876483 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 6HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054034","type":"LOCAL"},{"code":"876484","type":"LOCAL"}],"standard_charges":[{"gross_charge":2008.83,"discounted_cash":1506.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054034 = Hospital System Supply Identifier | 876484 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 7HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054035","type":"LOCAL"},{"code":"876485","type":"LOCAL"}],"standard_charges":[{"gross_charge":2045.17,"discounted_cash":1533.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054035 = Hospital System Supply Identifier | 876485 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 8HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054036","type":"LOCAL"},{"code":"876486","type":"LOCAL"}],"standard_charges":[{"gross_charge":2045.17,"discounted_cash":1533.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054036 = Hospital System Supply Identifier | 876486 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING 12-HOLE","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357185","type":"LOCAL"},{"code":"1083724","type":"LOCAL"}],"standard_charges":[{"gross_charge":2329.65,"discounted_cash":1747.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357185 = Hospital System Supply Identifier | 1083724 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 10HL","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054037","type":"LOCAL"},{"code":"876487","type":"LOCAL"}],"standard_charges":[{"gross_charge":2116.1,"discounted_cash":1587.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054037 = Hospital System Supply Identifier | 876487 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 8HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054039","type":"LOCAL"},{"code":"876489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1485.47,"discounted_cash":1114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054039 = Hospital System Supply Identifier | 876489 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 4HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054038","type":"LOCAL"},{"code":"876488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1432.42,"discounted_cash":1074.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054038 = Hospital System Supply Identifier | 876488 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 12H","code_information":[{"code":"Sx00-1005-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054040","type":"LOCAL"},{"code":"876490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2128.5,"discounted_cash":1596.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054040 = Hospital System Supply Identifier | 876490 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X8MM","code_information":[{"code":"Sx00-1005-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054041","type":"LOCAL"},{"code":"876491","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054041 = Hospital System Supply Identifier | 876491 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X10MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054042","type":"LOCAL"},{"code":"876492","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054042 = Hospital System Supply Identifier | 876492 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X12MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054043","type":"LOCAL"},{"code":"876493","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054043 = Hospital System Supply Identifier | 876493 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X14MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054044","type":"LOCAL"},{"code":"876494","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054044 = Hospital System Supply Identifier | 876494 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X16MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054045","type":"LOCAL"},{"code":"876495","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054045 = Hospital System Supply Identifier | 876495 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X18MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054046","type":"LOCAL"},{"code":"876496","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054046 = Hospital System Supply Identifier | 876496 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X20MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054047","type":"LOCAL"},{"code":"876497","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054047 = Hospital System Supply Identifier | 876497 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X22MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054048","type":"LOCAL"},{"code":"876498","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054048 = Hospital System Supply Identifier | 876498 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X24MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054049","type":"LOCAL"},{"code":"876499","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054049 = Hospital System Supply Identifier | 876499 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X26MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054050","type":"LOCAL"},{"code":"876500","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054050 = Hospital System Supply Identifier | 876500 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X28MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054051","type":"LOCAL"},{"code":"876501","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054051 = Hospital System Supply Identifier | 876501 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X38MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054056","type":"LOCAL"},{"code":"876506","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054056 = Hospital System Supply Identifier | 876506 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X36MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054055","type":"LOCAL"},{"code":"876505","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054055 = Hospital System Supply Identifier | 876505 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X30MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054052","type":"LOCAL"},{"code":"876502","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054052 = Hospital System Supply Identifier | 876502 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X32MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054053","type":"LOCAL"},{"code":"876503","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054053 = Hospital System Supply Identifier | 876503 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X34MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054054","type":"LOCAL"},{"code":"876504","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054054 = Hospital System Supply Identifier | 876504 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X40MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054057","type":"LOCAL"},{"code":"876507","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054057 = Hospital System Supply Identifier | 876507 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X45MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054058","type":"LOCAL"},{"code":"876508","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054058 = Hospital System Supply Identifier | 876508 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X50MM","code_information":[{"code":"Sx00-1005-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054059","type":"LOCAL"},{"code":"876509","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054059 = Hospital System Supply Identifier | 876509 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X8MM","code_information":[{"code":"Sx00-1005-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054060","type":"LOCAL"},{"code":"876510","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054060 = Hospital System Supply Identifier | 876510 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X18MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054065","type":"LOCAL"},{"code":"876515","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054065 = Hospital System Supply Identifier | 876515 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X16MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054064","type":"LOCAL"},{"code":"876514","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054064 = Hospital System Supply Identifier | 876514 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X10MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054061","type":"LOCAL"},{"code":"876511","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054061 = Hospital System Supply Identifier | 876511 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X12MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054062","type":"LOCAL"},{"code":"876512","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054062 = Hospital System Supply Identifier | 876512 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X14MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054063","type":"LOCAL"},{"code":"876513","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054063 = Hospital System Supply Identifier | 876513 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X20MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054066","type":"LOCAL"},{"code":"876516","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054066 = Hospital System Supply Identifier | 876516 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X22MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054067","type":"LOCAL"},{"code":"876517","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054067 = Hospital System Supply Identifier | 876517 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X24MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054068","type":"LOCAL"},{"code":"876518","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054068 = Hospital System Supply Identifier | 876518 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X26MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054069","type":"LOCAL"},{"code":"876519","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054069 = Hospital System Supply Identifier | 876519 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X28MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054070","type":"LOCAL"},{"code":"876520","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054070 = Hospital System Supply Identifier | 876520 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X30MM","code_information":[{"code":"Sx00-1005-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054071","type":"LOCAL"},{"code":"876521","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054071 = Hospital System Supply Identifier | 876521 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 9HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054076","type":"LOCAL"},{"code":"876526","type":"LOCAL"}],"standard_charges":[{"gross_charge":969.89,"discounted_cash":727.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054076 = Hospital System Supply Identifier | 876526 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 8HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054075","type":"LOCAL"},{"code":"876525","type":"LOCAL"}],"standard_charges":[{"gross_charge":925.01,"discounted_cash":693.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054075 = Hospital System Supply Identifier | 876525 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 7HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054074","type":"LOCAL"},{"code":"876524","type":"LOCAL"}],"standard_charges":[{"gross_charge":925.01,"discounted_cash":693.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054074 = Hospital System Supply Identifier | 876524 = Lawson ID"}]},{"description":"PLATE BONE 1/3 TUBULAR NSTRL 5","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942929","type":"LOCAL"},{"code":"827489","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.28,"discounted_cash":666.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 942929 = Hospital System Supply Identifier | 827489 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 4HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054072","type":"LOCAL"},{"code":"876522","type":"LOCAL"}],"standard_charges":[{"gross_charge":851.54,"discounted_cash":638.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054072 = Hospital System Supply Identifier | 876522 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 6HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054073","type":"LOCAL"},{"code":"876523","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.28,"discounted_cash":666.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054073 = Hospital System Supply Identifier | 876523 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 10HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054077","type":"LOCAL"},{"code":"876527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1050.87,"discounted_cash":788.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054077 = Hospital System Supply Identifier | 876527 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 12HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054078","type":"LOCAL"},{"code":"876528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054078 = Hospital System Supply Identifier | 876528 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 8HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054083","type":"LOCAL"},{"code":"876533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1521.95,"discounted_cash":1141.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054083 = Hospital System Supply Identifier | 876533 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 6HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054081","type":"LOCAL"},{"code":"876531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1465.58,"discounted_cash":1099.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054081 = Hospital System Supply Identifier | 876531 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 7HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054082","type":"LOCAL"},{"code":"876532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1521.95,"discounted_cash":1141.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054082 = Hospital System Supply Identifier | 876532 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 4HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054079","type":"LOCAL"},{"code":"876529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1360.98,"discounted_cash":1020.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054079 = Hospital System Supply Identifier | 876529 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 5HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054080","type":"LOCAL"},{"code":"876530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1412.53,"discounted_cash":1059.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054080 = Hospital System Supply Identifier | 876530 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 10HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054084","type":"LOCAL"},{"code":"876534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1575.0,"discounted_cash":1181.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054084 = Hospital System Supply Identifier | 876534 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 12HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054085","type":"LOCAL"},{"code":"876535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1730.14,"discounted_cash":1297.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054085 = Hospital System Supply Identifier | 876535 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 16HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054086","type":"LOCAL"},{"code":"876536","type":"LOCAL"}],"standard_charges":[{"gross_charge":1730.14,"discounted_cash":1297.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054086 = Hospital System Supply Identifier | 876536 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 18HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054087","type":"LOCAL"},{"code":"876537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1834.5,"discounted_cash":1375.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054087 = Hospital System Supply Identifier | 876537 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 20HL","code_information":[{"code":"Sx00-1005-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054088","type":"LOCAL"},{"code":"876538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1834.5,"discounted_cash":1375.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054088 = Hospital System Supply Identifier | 876538 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054090","type":"LOCAL"},{"code":"876540","type":"LOCAL"}],"standard_charges":[{"gross_charge":2324.29,"discounted_cash":1743.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054090 = Hospital System Supply Identifier | 876540 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054089","type":"LOCAL"},{"code":"876539","type":"LOCAL"}],"standard_charges":[{"gross_charge":2078.21,"discounted_cash":1558.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054089 = Hospital System Supply Identifier | 876539 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054091","type":"LOCAL"},{"code":"876541","type":"LOCAL"}],"standard_charges":[{"gross_charge":2548.16,"discounted_cash":1911.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054091 = Hospital System Supply Identifier | 876541 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 16 HOLE","code_information":[{"code":"Sx00-1005-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054092","type":"LOCAL"},{"code":"876542","type":"LOCAL"}],"standard_charges":[{"gross_charge":2776.05,"discounted_cash":2082.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054092 = Hospital System Supply Identifier | 876542 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 3HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054093","type":"LOCAL"},{"code":"876543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":1166.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054093 = Hospital System Supply Identifier | 876543 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 5HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054094","type":"LOCAL"},{"code":"876544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1664.53,"discounted_cash":1248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054094 = Hospital System Supply Identifier | 876544 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 3HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054095","type":"LOCAL"},{"code":"876545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":1166.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054095 = Hospital System Supply Identifier | 876545 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 5HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054096","type":"LOCAL"},{"code":"876546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1664.53,"discounted_cash":1248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054096 = Hospital System Supply Identifier | 876546 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 7HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054097","type":"LOCAL"},{"code":"876547","type":"LOCAL"}],"standard_charges":[{"gross_charge":2131.08,"discounted_cash":1598.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054097 = Hospital System Supply Identifier | 876547 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054102","type":"LOCAL"},{"code":"876552","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054102 = Hospital System Supply Identifier | 876552 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 14","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054100","type":"LOCAL"},{"code":"876550","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054100 = Hospital System Supply Identifier | 876550 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054101","type":"LOCAL"},{"code":"876551","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054101 = Hospital System Supply Identifier | 876551 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 10","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054098","type":"LOCAL"},{"code":"876548","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054098 = Hospital System Supply Identifier | 876548 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 12","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054099","type":"LOCAL"},{"code":"876549","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054099 = Hospital System Supply Identifier | 876549 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054103","type":"LOCAL"},{"code":"876553","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054103 = Hospital System Supply Identifier | 876553 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054104","type":"LOCAL"},{"code":"876554","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054104 = Hospital System Supply Identifier | 876554 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054105","type":"LOCAL"},{"code":"876555","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054105 = Hospital System Supply Identifier | 876555 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054106","type":"LOCAL"},{"code":"876556","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054106 = Hospital System Supply Identifier | 876556 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054107","type":"LOCAL"},{"code":"876557","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054107 = Hospital System Supply Identifier | 876557 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054111","type":"LOCAL"},{"code":"876561","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054111 = Hospital System Supply Identifier | 876561 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054113","type":"LOCAL"},{"code":"876563","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054113 = Hospital System Supply Identifier | 876563 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054112","type":"LOCAL"},{"code":"876562","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054112 = Hospital System Supply Identifier | 876562 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054110","type":"LOCAL"},{"code":"876560","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054110 = Hospital System Supply Identifier | 876560 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054109","type":"LOCAL"},{"code":"876559","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054109 = Hospital System Supply Identifier | 876559 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054108","type":"LOCAL"},{"code":"876558","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054108 = Hospital System Supply Identifier | 876558 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054114","type":"LOCAL"},{"code":"876564","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054114 = Hospital System Supply Identifier | 876564 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054115","type":"LOCAL"},{"code":"876565","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054115 = Hospital System Supply Identifier | 876565 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054116","type":"LOCAL"},{"code":"876566","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054116 = Hospital System Supply Identifier | 876566 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054117","type":"LOCAL"},{"code":"876567","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054117 = Hospital System Supply Identifier | 876567 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054118","type":"LOCAL"},{"code":"876568","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054118 = Hospital System Supply Identifier | 876568 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054119","type":"LOCAL"},{"code":"876569","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054119 = Hospital System Supply Identifier | 876569 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054120","type":"LOCAL"},{"code":"876570","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054120 = Hospital System Supply Identifier | 876570 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054121","type":"LOCAL"},{"code":"876571","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054121 = Hospital System Supply Identifier | 876571 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054122","type":"LOCAL"},{"code":"876572","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054122 = Hospital System Supply Identifier | 876572 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054124","type":"LOCAL"},{"code":"876574","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054124 = Hospital System Supply Identifier | 876574 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054123","type":"LOCAL"},{"code":"876573","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054123 = Hospital System Supply Identifier | 876573 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054125","type":"LOCAL"},{"code":"876575","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054125 = Hospital System Supply Identifier | 876575 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054126","type":"LOCAL"},{"code":"876576","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054126 = Hospital System Supply Identifier | 876576 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054127","type":"LOCAL"},{"code":"876577","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054127 = Hospital System Supply Identifier | 876577 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054128","type":"LOCAL"},{"code":"876578","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054128 = Hospital System Supply Identifier | 876578 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054129","type":"LOCAL"},{"code":"876579","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054129 = Hospital System Supply Identifier | 876579 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054135","type":"LOCAL"},{"code":"876585","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054135 = Hospital System Supply Identifier | 876585 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054133","type":"LOCAL"},{"code":"876583","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054133 = Hospital System Supply Identifier | 876583 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054134","type":"LOCAL"},{"code":"876584","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054134 = Hospital System Supply Identifier | 876584 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054131","type":"LOCAL"},{"code":"876581","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054131 = Hospital System Supply Identifier | 876581 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054130","type":"LOCAL"},{"code":"876580","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054130 = Hospital System Supply Identifier | 876580 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054132","type":"LOCAL"},{"code":"876582","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054132 = Hospital System Supply Identifier | 876582 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054136","type":"LOCAL"},{"code":"876586","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054136 = Hospital System Supply Identifier | 876586 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054137","type":"LOCAL"},{"code":"876587","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054137 = Hospital System Supply Identifier | 876587 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054138","type":"LOCAL"},{"code":"876588","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054138 = Hospital System Supply Identifier | 876588 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054139","type":"LOCAL"},{"code":"876589","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054139 = Hospital System Supply Identifier | 876589 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054140","type":"LOCAL"},{"code":"876590","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054140 = Hospital System Supply Identifier | 876590 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054141","type":"LOCAL"},{"code":"876591","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054141 = Hospital System Supply Identifier | 876591 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054142","type":"LOCAL"},{"code":"876592","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054142 = Hospital System Supply Identifier | 876592 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054143","type":"LOCAL"},{"code":"876593","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054143 = Hospital System Supply Identifier | 876593 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054144","type":"LOCAL"},{"code":"876594","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054144 = Hospital System Supply Identifier | 876594 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054145","type":"LOCAL"},{"code":"876595","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054145 = Hospital System Supply Identifier | 876595 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054146","type":"LOCAL"},{"code":"876596","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054146 = Hospital System Supply Identifier | 876596 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054147","type":"LOCAL"},{"code":"876597","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054147 = Hospital System Supply Identifier | 876597 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054148","type":"LOCAL"},{"code":"876598","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054148 = Hospital System Supply Identifier | 876598 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054149","type":"LOCAL"},{"code":"876599","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054149 = Hospital System Supply Identifier | 876599 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054150","type":"LOCAL"},{"code":"876600","type":"LOCAL"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":2293.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054150 = Hospital System Supply Identifier | 876600 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054151","type":"LOCAL"},{"code":"876601","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054151 = Hospital System Supply Identifier | 876601 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054152","type":"LOCAL"},{"code":"876602","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054152 = Hospital System Supply Identifier | 876602 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054153","type":"LOCAL"},{"code":"876603","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054153 = Hospital System Supply Identifier | 876603 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054156","type":"LOCAL"},{"code":"876606","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054156 = Hospital System Supply Identifier | 876606 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054154","type":"LOCAL"},{"code":"876604","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054154 = Hospital System Supply Identifier | 876604 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054155","type":"LOCAL"},{"code":"876605","type":"LOCAL"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2700.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054155 = Hospital System Supply Identifier | 876605 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 99MM","code_information":[{"code":"Sx00-1005-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054157","type":"LOCAL"},{"code":"876607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054157 = Hospital System Supply Identifier | 876607 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 112MM","code_information":[{"code":"Sx00-1005-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054158","type":"LOCAL"},{"code":"876608","type":"LOCAL"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":3105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054158 = Hospital System Supply Identifier | 876608 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 12MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054159","type":"LOCAL"},{"code":"876609","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054159 = Hospital System Supply Identifier | 876609 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 15MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054160","type":"LOCAL"},{"code":"876610","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054160 = Hospital System Supply Identifier | 876610 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 18MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054161","type":"LOCAL"},{"code":"876611","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054161 = Hospital System Supply Identifier | 876611 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 21MM","code_information":[{"code":"Sx00-1007-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054162","type":"LOCAL"},{"code":"876612","type":"LOCAL"}],"standard_charges":[{"gross_charge":4173.12,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054162 = Hospital System Supply Identifier | 876612 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 12MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054163","type":"LOCAL"},{"code":"876613","type":"LOCAL"}],"standard_charges":[{"gross_charge":4714.08,"discounted_cash":3535.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054163 = Hospital System Supply Identifier | 876613 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 15MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054164","type":"LOCAL"},{"code":"876614","type":"LOCAL"}],"standard_charges":[{"gross_charge":4714.08,"discounted_cash":3535.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054164 = Hospital System Supply Identifier | 876614 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054165","type":"LOCAL"},{"code":"876615","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054165 = Hospital System Supply Identifier | 876615 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054166","type":"LOCAL"},{"code":"876616","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054166 = Hospital System Supply Identifier | 876616 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054167","type":"LOCAL"},{"code":"876617","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054167 = Hospital System Supply Identifier | 876617 = Lawson ID"}]},{"description":"PLATE CLOVER 2.7MM 4HL","code_information":[{"code":"Sx00-1007-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054168","type":"LOCAL"},{"code":"876618","type":"LOCAL"}],"standard_charges":[{"gross_charge":3424.96,"discounted_cash":2568.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054168 = Hospital System Supply Identifier | 876618 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 15MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054169","type":"LOCAL"},{"code":"876619","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054169 = Hospital System Supply Identifier | 876619 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054170","type":"LOCAL"},{"code":"876620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054170 = Hospital System Supply Identifier | 876620 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054171","type":"LOCAL"},{"code":"876621","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054171 = Hospital System Supply Identifier | 876621 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054172","type":"LOCAL"},{"code":"876622","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054172 = Hospital System Supply Identifier | 876622 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 27MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054173","type":"LOCAL"},{"code":"876623","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054173 = Hospital System Supply Identifier | 876623 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 30MM","code_information":[{"code":"Sx00-1007-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054174","type":"LOCAL"},{"code":"876624","type":"LOCAL"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":3869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054174 = Hospital System Supply Identifier | 876624 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 2HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054175","type":"LOCAL"},{"code":"876625","type":"LOCAL"}],"standard_charges":[{"gross_charge":3102.48,"discounted_cash":2326.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054175 = Hospital System Supply Identifier | 876625 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 4HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054176","type":"LOCAL"},{"code":"876626","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054176 = Hospital System Supply Identifier | 876626 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 6HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054177","type":"LOCAL"},{"code":"876627","type":"LOCAL"}],"standard_charges":[{"gross_charge":4658.88,"discounted_cash":3494.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054177 = Hospital System Supply Identifier | 876627 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 8HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054178","type":"LOCAL"},{"code":"876628","type":"LOCAL"}],"standard_charges":[{"gross_charge":5412.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054178 = Hospital System Supply Identifier | 876628 = Lawson ID"}]},{"description":"ANGLE IRON 2.7MM 5MM","code_information":[{"code":"Sx00-1007-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054179","type":"LOCAL"},{"code":"876629","type":"LOCAL"}],"standard_charges":[{"gross_charge":3878.0,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054179 = Hospital System Supply Identifier | 876629 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 2MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054180","type":"LOCAL"},{"code":"876630","type":"LOCAL"}],"standard_charges":[{"gross_charge":5390.0,"discounted_cash":4042.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054180 = Hospital System Supply Identifier | 876630 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054181","type":"LOCAL"},{"code":"876631","type":"LOCAL"}],"standard_charges":[{"gross_charge":5600.56,"discounted_cash":4200.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054181 = Hospital System Supply Identifier | 876631 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 15MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054182","type":"LOCAL"},{"code":"876632","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054182 = Hospital System Supply Identifier | 876632 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 18MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054183","type":"LOCAL"},{"code":"876633","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054183 = Hospital System Supply Identifier | 876633 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 24MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054185","type":"LOCAL"},{"code":"876635","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054185 = Hospital System Supply Identifier | 876635 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 21MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054184","type":"LOCAL"},{"code":"876634","type":"LOCAL"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":3753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054184 = Hospital System Supply Identifier | 876634 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 15MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054186","type":"LOCAL"},{"code":"876636","type":"LOCAL"}],"standard_charges":[{"gross_charge":5611.52,"discounted_cash":4208.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054186 = Hospital System Supply Identifier | 876636 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 18MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054187","type":"LOCAL"},{"code":"876637","type":"LOCAL"}],"standard_charges":[{"gross_charge":5611.52,"discounted_cash":4208.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054187 = Hospital System Supply Identifier | 876637 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054188","type":"LOCAL"},{"code":"876638","type":"LOCAL"}],"standard_charges":[{"gross_charge":5984.16,"discounted_cash":4488.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054188 = Hospital System Supply Identifier | 876638 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054189","type":"LOCAL"},{"code":"876639","type":"LOCAL"}],"standard_charges":[{"gross_charge":5984.16,"discounted_cash":4488.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054189 = Hospital System Supply Identifier | 876639 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054190","type":"LOCAL"},{"code":"876640","type":"LOCAL"}],"standard_charges":[{"gross_charge":5984.16,"discounted_cash":4488.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054190 = Hospital System Supply Identifier | 876640 = Lawson ID"}]},{"description":"PLATE CLOVER 3.5MM 4HL","code_information":[{"code":"Sx00-1007-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054191","type":"LOCAL"},{"code":"876641","type":"LOCAL"}],"standard_charges":[{"gross_charge":5087.5,"discounted_cash":3815.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054191 = Hospital System Supply Identifier | 876641 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 18MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054193","type":"LOCAL"},{"code":"876643","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054193 = Hospital System Supply Identifier | 876643 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 15MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054192","type":"LOCAL"},{"code":"876642","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054192 = Hospital System Supply Identifier | 876642 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054196","type":"LOCAL"},{"code":"876646","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054196 = Hospital System Supply Identifier | 876646 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054195","type":"LOCAL"},{"code":"876645","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054195 = Hospital System Supply Identifier | 876645 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054194","type":"LOCAL"},{"code":"876644","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054194 = Hospital System Supply Identifier | 876644 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 30MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054197","type":"LOCAL"},{"code":"876647","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054197 = Hospital System Supply Identifier | 876647 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 33MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054198","type":"LOCAL"},{"code":"876648","type":"LOCAL"}],"standard_charges":[{"gross_charge":6147.96,"discounted_cash":4610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054198 = Hospital System Supply Identifier | 876648 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054201","type":"LOCAL"},{"code":"876651","type":"LOCAL"}],"standard_charges":[{"gross_charge":5534.8,"discounted_cash":4151.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054201 = Hospital System Supply Identifier | 876651 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 2HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054199","type":"LOCAL"},{"code":"876649","type":"LOCAL"}],"standard_charges":[{"gross_charge":3711.8,"discounted_cash":2783.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054199 = Hospital System Supply Identifier | 876649 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054200","type":"LOCAL"},{"code":"876650","type":"LOCAL"}],"standard_charges":[{"gross_charge":4636.8,"discounted_cash":3477.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054200 = Hospital System Supply Identifier | 876650 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054202","type":"LOCAL"},{"code":"876652","type":"LOCAL"}],"standard_charges":[{"gross_charge":6442.8,"discounted_cash":4832.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054202 = Hospital System Supply Identifier | 876652 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 6MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054204","type":"LOCAL"},{"code":"876654","type":"LOCAL"}],"standard_charges":[{"gross_charge":6661.2,"discounted_cash":4995.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054204 = Hospital System Supply Identifier | 876654 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054203","type":"LOCAL"},{"code":"876653","type":"LOCAL"}],"standard_charges":[{"gross_charge":6420.96,"discounted_cash":4815.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054203 = Hospital System Supply Identifier | 876653 = Lawson ID"}]},{"description":"ANGLE IRON 3.5MM 6MM","code_information":[{"code":"Sx00-1007-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054205","type":"LOCAL"},{"code":"876655","type":"LOCAL"}],"standard_charges":[{"gross_charge":4636.8,"discounted_cash":3477.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054205 = Hospital System Supply Identifier | 876655 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X8MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054207","type":"LOCAL"},{"code":"876657","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054207 = Hospital System Supply Identifier | 876657 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X6MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054206","type":"LOCAL"},{"code":"876656","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054206 = Hospital System Supply Identifier | 876656 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X10MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054208","type":"LOCAL"},{"code":"876658","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054208 = Hospital System Supply Identifier | 876658 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X12MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054209","type":"LOCAL"},{"code":"876659","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054209 = Hospital System Supply Identifier | 876659 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X14MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054210","type":"LOCAL"},{"code":"876660","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054210 = Hospital System Supply Identifier | 876660 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X16MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054211","type":"LOCAL"},{"code":"876661","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054211 = Hospital System Supply Identifier | 876661 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X18MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054212","type":"LOCAL"},{"code":"876662","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054212 = Hospital System Supply Identifier | 876662 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X28MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054217","type":"LOCAL"},{"code":"876667","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054217 = Hospital System Supply Identifier | 876667 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X24MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054215","type":"LOCAL"},{"code":"876665","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054215 = Hospital System Supply Identifier | 876665 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X26MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054216","type":"LOCAL"},{"code":"876666","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054216 = Hospital System Supply Identifier | 876666 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X20MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054213","type":"LOCAL"},{"code":"876663","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054213 = Hospital System Supply Identifier | 876663 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X22MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054214","type":"LOCAL"},{"code":"876664","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054214 = Hospital System Supply Identifier | 876664 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X30MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054218","type":"LOCAL"},{"code":"876668","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054218 = Hospital System Supply Identifier | 876668 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X32MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054219","type":"LOCAL"},{"code":"876669","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054219 = Hospital System Supply Identifier | 876669 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X34MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054220","type":"LOCAL"},{"code":"876670","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054220 = Hospital System Supply Identifier | 876670 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X36MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054221","type":"LOCAL"},{"code":"876671","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054221 = Hospital System Supply Identifier | 876671 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X38MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054222","type":"LOCAL"},{"code":"876672","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054222 = Hospital System Supply Identifier | 876672 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X48MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054225","type":"LOCAL"},{"code":"876675","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054225 = Hospital System Supply Identifier | 876675 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X40MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054223","type":"LOCAL"},{"code":"876673","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054223 = Hospital System Supply Identifier | 876673 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X44MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054224","type":"LOCAL"},{"code":"876674","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054224 = Hospital System Supply Identifier | 876674 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X56MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054227","type":"LOCAL"},{"code":"876677","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054227 = Hospital System Supply Identifier | 876677 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X52MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054226","type":"LOCAL"},{"code":"876676","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054226 = Hospital System Supply Identifier | 876676 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X60MM","code_information":[{"code":"Sx00-1007-276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054228","type":"LOCAL"},{"code":"876678","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054228 = Hospital System Supply Identifier | 876678 = Lawson ID"}]},{"description":"SCREW CORT 2.7X6MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054229","type":"LOCAL"},{"code":"876679","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054229 = Hospital System Supply Identifier | 876679 = Lawson ID"}]},{"description":"SCREW CORT 2.7X8MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054230","type":"LOCAL"},{"code":"876680","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054230 = Hospital System Supply Identifier | 876680 = Lawson ID"}]},{"description":"SCREW CORT 2.7X10MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054231","type":"LOCAL"},{"code":"876681","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054231 = Hospital System Supply Identifier | 876681 = Lawson ID"}]},{"description":"SCREW CORT 2.7X12MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054232","type":"LOCAL"},{"code":"876682","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054232 = Hospital System Supply Identifier | 876682 = Lawson ID"}]},{"description":"SCREW CORT 2.7X14MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054233","type":"LOCAL"},{"code":"876683","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054233 = Hospital System Supply Identifier | 876683 = Lawson ID"}]},{"description":"SCREW CORT 2.7X16MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054234","type":"LOCAL"},{"code":"876684","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054234 = Hospital System Supply Identifier | 876684 = Lawson ID"}]},{"description":"SCREW CORT 2.7X18MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054235","type":"LOCAL"},{"code":"876685","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054235 = Hospital System Supply Identifier | 876685 = Lawson ID"}]},{"description":"SCREW CORT 2.7X28MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054240","type":"LOCAL"},{"code":"876690","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054240 = Hospital System Supply Identifier | 876690 = Lawson ID"}]},{"description":"SCREW CORT 2.7X26MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054239","type":"LOCAL"},{"code":"876689","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054239 = Hospital System Supply Identifier | 876689 = Lawson ID"}]},{"description":"SCREW CORT 2.7X22MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054237","type":"LOCAL"},{"code":"876687","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054237 = Hospital System Supply Identifier | 876687 = Lawson ID"}]},{"description":"SCREW CORT 2.7X20MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054236","type":"LOCAL"},{"code":"876686","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054236 = Hospital System Supply Identifier | 876686 = Lawson ID"}]},{"description":"SCREW CORT 2.7X24MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054238","type":"LOCAL"},{"code":"876688","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054238 = Hospital System Supply Identifier | 876688 = Lawson ID"}]},{"description":"SCREW CORT 2.7X38MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054245","type":"LOCAL"},{"code":"876695","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054245 = Hospital System Supply Identifier | 876695 = Lawson ID"}]},{"description":"SCREW CORT 2.7X30MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054241","type":"LOCAL"},{"code":"876691","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054241 = Hospital System Supply Identifier | 876691 = Lawson ID"}]},{"description":"SCREW CORT 2.7X32MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054242","type":"LOCAL"},{"code":"876692","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054242 = Hospital System Supply Identifier | 876692 = Lawson ID"}]},{"description":"SCREW CORT 2.7X34MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054243","type":"LOCAL"},{"code":"876693","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054243 = Hospital System Supply Identifier | 876693 = Lawson ID"}]},{"description":"SCREW CORT 2.7X36MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054244","type":"LOCAL"},{"code":"876694","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054244 = Hospital System Supply Identifier | 876694 = Lawson ID"}]},{"description":"SCREW CORT 2.7X44MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054247","type":"LOCAL"},{"code":"876697","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054247 = Hospital System Supply Identifier | 876697 = Lawson ID"}]},{"description":"SCREW CORT 2.7X48MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054248","type":"LOCAL"},{"code":"876698","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054248 = Hospital System Supply Identifier | 876698 = Lawson ID"}]},{"description":"SCREW CORT 2.7X40MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054246","type":"LOCAL"},{"code":"876696","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054246 = Hospital System Supply Identifier | 876696 = Lawson ID"}]},{"description":"SCREW CORT 2.7X52MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054249","type":"LOCAL"},{"code":"876699","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054249 = Hospital System Supply Identifier | 876699 = Lawson ID"}]},{"description":"SCREW CORT 2.7X56MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054250","type":"LOCAL"},{"code":"876700","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054250 = Hospital System Supply Identifier | 876700 = Lawson ID"}]},{"description":"SCREW CORT 2.7X60MM","code_information":[{"code":"Sx00-1007-286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054251","type":"LOCAL"},{"code":"876701","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.8,"discounted_cash":351.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054251 = Hospital System Supply Identifier | 876701 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X8MM","code_information":[{"code":"Sx00-1007-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054252","type":"LOCAL"},{"code":"876702","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054252 = Hospital System Supply Identifier | 876702 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X10MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054253","type":"LOCAL"},{"code":"876703","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054253 = Hospital System Supply Identifier | 876703 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X12MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054254","type":"LOCAL"},{"code":"876704","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054254 = Hospital System Supply Identifier | 876704 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X14MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054255","type":"LOCAL"},{"code":"876705","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054255 = Hospital System Supply Identifier | 876705 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X16MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054256","type":"LOCAL"},{"code":"876706","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054256 = Hospital System Supply Identifier | 876706 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X18MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054257","type":"LOCAL"},{"code":"876707","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054257 = Hospital System Supply Identifier | 876707 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X28MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054262","type":"LOCAL"},{"code":"876712","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054262 = Hospital System Supply Identifier | 876712 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X26MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054261","type":"LOCAL"},{"code":"876711","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054261 = Hospital System Supply Identifier | 876711 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X20MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054258","type":"LOCAL"},{"code":"876708","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054258 = Hospital System Supply Identifier | 876708 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X22MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054259","type":"LOCAL"},{"code":"876709","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054259 = Hospital System Supply Identifier | 876709 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X24MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054260","type":"LOCAL"},{"code":"876710","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054260 = Hospital System Supply Identifier | 876710 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X38MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054267","type":"LOCAL"},{"code":"876717","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054267 = Hospital System Supply Identifier | 876717 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X30MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054263","type":"LOCAL"},{"code":"876713","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054263 = Hospital System Supply Identifier | 876713 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X32MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054264","type":"LOCAL"},{"code":"876714","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054264 = Hospital System Supply Identifier | 876714 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X34MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054265","type":"LOCAL"},{"code":"876715","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054265 = Hospital System Supply Identifier | 876715 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X36MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054266","type":"LOCAL"},{"code":"876716","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054266 = Hospital System Supply Identifier | 876716 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X48MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054270","type":"LOCAL"},{"code":"876720","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054270 = Hospital System Supply Identifier | 876720 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X44MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054269","type":"LOCAL"},{"code":"876719","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054269 = Hospital System Supply Identifier | 876719 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X40MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054268","type":"LOCAL"},{"code":"876718","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054268 = Hospital System Supply Identifier | 876718 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X52MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054271","type":"LOCAL"},{"code":"876721","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054271 = Hospital System Supply Identifier | 876721 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X56MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054272","type":"LOCAL"},{"code":"876722","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054272 = Hospital System Supply Identifier | 876722 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X60MM","code_information":[{"code":"Sx00-1007-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054273","type":"LOCAL"},{"code":"876723","type":"LOCAL"}],"standard_charges":[{"gross_charge":894.28,"discounted_cash":670.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054273 = Hospital System Supply Identifier | 876723 = Lawson ID"}]},{"description":"SCREW CORT 3.5X8MM","code_information":[{"code":"Sx00-1007-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054274","type":"LOCAL"},{"code":"876724","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054274 = Hospital System Supply Identifier | 876724 = Lawson ID"}]},{"description":"SCREW CORT 3.5X10MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054275","type":"LOCAL"},{"code":"876725","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054275 = Hospital System Supply Identifier | 876725 = Lawson ID"}]},{"description":"SCREW CORT 3.5X12MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054276","type":"LOCAL"},{"code":"876726","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054276 = Hospital System Supply Identifier | 876726 = Lawson ID"}]},{"description":"SCREW CORT 3.5X14MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054277","type":"LOCAL"},{"code":"876727","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054277 = Hospital System Supply Identifier | 876727 = Lawson ID"}]},{"description":"SCREW CORT 3.5X16MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054278","type":"LOCAL"},{"code":"876728","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054278 = Hospital System Supply Identifier | 876728 = Lawson ID"}]},{"description":"SCREW CORT 3.5X18MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054279","type":"LOCAL"},{"code":"876729","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054279 = Hospital System Supply Identifier | 876729 = Lawson ID"}]},{"description":"SCREW CORT 3.5X28MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054284","type":"LOCAL"},{"code":"876734","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054284 = Hospital System Supply Identifier | 876734 = Lawson ID"}]},{"description":"SCREW CORT 3.5X20MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054280","type":"LOCAL"},{"code":"876730","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054280 = Hospital System Supply Identifier | 876730 = Lawson ID"}]},{"description":"SCREW CORT 3.5X22MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054281","type":"LOCAL"},{"code":"876731","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054281 = Hospital System Supply Identifier | 876731 = Lawson ID"}]},{"description":"SCREW CORT 3.5X24MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054282","type":"LOCAL"},{"code":"876732","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054282 = Hospital System Supply Identifier | 876732 = Lawson ID"}]},{"description":"SCREW CORT 3.5X26MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054283","type":"LOCAL"},{"code":"876733","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054283 = Hospital System Supply Identifier | 876733 = Lawson ID"}]},{"description":"SCREW CORT 3.5X34MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054287","type":"LOCAL"},{"code":"876737","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054287 = Hospital System Supply Identifier | 876737 = Lawson ID"}]},{"description":"SCREW CORT 3.5X38MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054289","type":"LOCAL"},{"code":"876739","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054289 = Hospital System Supply Identifier | 876739 = Lawson ID"}]},{"description":"SCREW CORT 3.5X30MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054285","type":"LOCAL"},{"code":"876735","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054285 = Hospital System Supply Identifier | 876735 = Lawson ID"}]},{"description":"SCREW CORT 3.5X32MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054286","type":"LOCAL"},{"code":"876736","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054286 = Hospital System Supply Identifier | 876736 = Lawson ID"}]},{"description":"SCREW CORT 3.5X36MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054288","type":"LOCAL"},{"code":"876738","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054288 = Hospital System Supply Identifier | 876738 = Lawson ID"}]},{"description":"SCREW CORT 3.5X48MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054292","type":"LOCAL"},{"code":"876742","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054292 = Hospital System Supply Identifier | 876742 = Lawson ID"}]},{"description":"SCREW CORT 3.5X40MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054290","type":"LOCAL"},{"code":"876740","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054290 = Hospital System Supply Identifier | 876740 = Lawson ID"}]},{"description":"SCREW CORT 3.5X44MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054291","type":"LOCAL"},{"code":"876741","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054291 = Hospital System Supply Identifier | 876741 = Lawson ID"}]},{"description":"SCREW CORT 3.5X52MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054293","type":"LOCAL"},{"code":"876743","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054293 = Hospital System Supply Identifier | 876743 = Lawson ID"}]},{"description":"SCREW CORT 3.5X56MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054294","type":"LOCAL"},{"code":"876744","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054294 = Hospital System Supply Identifier | 876744 = Lawson ID"}]},{"description":"SCREW CORT 3.5X60MM","code_information":[{"code":"Sx00-1007-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054295","type":"LOCAL"},{"code":"876745","type":"LOCAL"}],"standard_charges":[{"gross_charge":574.28,"discounted_cash":430.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054295 = Hospital System Supply Identifier | 876745 = Lawson ID"}]},{"description":"PLATE LVL1 MINI STR 20HL 100MM","code_information":[{"code":"Sx00-101-30-9","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700594","type":"LOCAL"},{"code":"723730","type":"LOCAL"}],"standard_charges":[{"gross_charge":241.22,"discounted_cash":180.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 700594 = Hospital System Supply Identifier | 723730 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 20MM","code_information":[{"code":"Sx00-101-56-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700596","type":"LOCAL"},{"code":"723732","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.51,"discounted_cash":227.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 700596 = Hospital System Supply Identifier | 723732 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 20MM","code_information":[{"code":"Sx00-101-57-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700597","type":"LOCAL"},{"code":"723733","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.51,"discounted_cash":227.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 700597 = Hospital System Supply Identifier | 723733 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 24MM","code_information":[{"code":"Sx00-101-58-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700598","type":"LOCAL"},{"code":"723734","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.12,"discounted_cash":165.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 700598 = Hospital System Supply Identifier | 723734 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 24MM","code_information":[{"code":"Sx00-101-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700599","type":"LOCAL"},{"code":"723735","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.12,"discounted_cash":165.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 700599 = Hospital System Supply Identifier | 723735 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356749","type":"LOCAL"},{"code":"1083608","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356749 = Hospital System Supply Identifier | 1083608 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356990","type":"LOCAL"},{"code":"1083538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356990 = Hospital System Supply Identifier | 1083538 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356711","type":"LOCAL"},{"code":"1083690","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356711 = Hospital System Supply Identifier | 1083690 = Lawson ID"}]},{"description":"PLATE-O DELTA 16MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899729","type":"LOCAL"},{"code":"593216","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 899729 = Hospital System Supply Identifier | 593216 = Lawson ID"}]},{"description":"PLATE DELTA 12MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054296","type":"LOCAL"},{"code":"876746","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054296 = Hospital System Supply Identifier | 876746 = Lawson ID"}]},{"description":"PLATE-O DELTA 24MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899728","type":"LOCAL"},{"code":"593215","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 899728 = Hospital System Supply Identifier | 593215 = Lawson ID"}]},{"description":"PLATE DELTA 20MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054297","type":"LOCAL"},{"code":"876747","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.91,"discounted_cash":1527.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054297 = Hospital System Supply Identifier | 876747 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 12MM","code_information":[{"code":"Sx00-1012-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833246","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833246 = Hospital System Supply Identifier"}]},{"description":"PLATE PEDI O W/HLDR 16MM","code_information":[{"code":"Sx00-1012-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"786764","type":"LOCAL"},{"code":"410073","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 786764 = Hospital System Supply Identifier | 410073 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 20MM","code_information":[{"code":"Sx00-1012-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"786763","type":"LOCAL"},{"code":"410074","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 786763 = Hospital System Supply Identifier | 410074 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 24MM","code_information":[{"code":"Sx00-1012-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833244","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833244 = Hospital System Supply Identifier"}]},{"description":"SCREW CANN DELTA 4.5X16MM","code_information":[{"code":"Sx00-1015-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899731","type":"LOCAL"},{"code":"593218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 899731 = Hospital System Supply Identifier | 593218 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X24MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899730","type":"LOCAL"},{"code":"593217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 899730 = Hospital System Supply Identifier | 593217 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X20MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899732","type":"LOCAL"},{"code":"593219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 899732 = Hospital System Supply Identifier | 593219 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X28MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054298","type":"LOCAL"},{"code":"876748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054298 = Hospital System Supply Identifier | 876748 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X32MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054299","type":"LOCAL"},{"code":"876749","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054299 = Hospital System Supply Identifier | 876749 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X36MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054300","type":"LOCAL"},{"code":"876750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1006.26,"discounted_cash":754.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054300 = Hospital System Supply Identifier | 876750 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X12MM","code_information":[{"code":"Sx00-1015-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063351","type":"LOCAL"},{"code":"418940","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1063351 = Hospital System Supply Identifier | 418940 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL SELF-TAPPING FT FOR-LAT","code_information":[{"code":"Sx00-1015-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356483","type":"LOCAL"},{"code":"1083673","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356483 = Hospital System Supply Identifier | 1083673 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X16MM","code_information":[{"code":"Sx00-1015-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063321","type":"LOCAL"},{"code":"399815","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1063321 = Hospital System Supply Identifier | 399815 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X18MM","code_information":[{"code":"Sx00-1015-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063352","type":"LOCAL"},{"code":"418942","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1063352 = Hospital System Supply Identifier | 418942 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X24MM","code_information":[{"code":"Sx00-1015-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063322","type":"LOCAL"},{"code":"399817","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1063322 = Hospital System Supply Identifier | 399817 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X26MM","code_information":[{"code":"Sx00-1015-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063353","type":"LOCAL"},{"code":"418944","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1063353 = Hospital System Supply Identifier | 418944 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL ST","code_information":[{"code":"Sx00-1015-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356841","type":"LOCAL"},{"code":"1083629","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356841 = Hospital System Supply Identifier | 1083629 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT DIST FEM","code_information":[{"code":"Sx00-1015-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356633","type":"LOCAL"},{"code":"1083563","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356633 = Hospital System Supply Identifier | 1083563 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT LAT DIST FEM","code_information":[{"code":"Sx00-1015-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357108","type":"LOCAL"},{"code":"1083682","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357108 = Hospital System Supply Identifier | 1083682 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356484","type":"LOCAL"},{"code":"1083676","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356484 = Hospital System Supply Identifier | 1083676 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357258","type":"LOCAL"},{"code":"1083560","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357258 = Hospital System Supply Identifier | 1083560 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356968","type":"LOCAL"},{"code":"1083601","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356968 = Hospital System Supply Identifier | 1083601 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356878","type":"LOCAL"},{"code":"1083646","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356878 = Hospital System Supply Identifier | 1083646 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356502","type":"LOCAL"},{"code":"1083652","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356502 = Hospital System Supply Identifier | 1083652 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356755","type":"LOCAL"},{"code":"1083606","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356755 = Hospital System Supply Identifier | 1083606 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357234","type":"LOCAL"},{"code":"1083678","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357234 = Hospital System Supply Identifier | 1083678 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356754","type":"LOCAL"},{"code":"1083567","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356754 = Hospital System Supply Identifier | 1083567 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357260","type":"LOCAL"},{"code":"1083541","type":"LOCAL"}],"standard_charges":[{"gross_charge":130.47,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357260 = Hospital System Supply Identifier | 1083541 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X16MM","code_information":[{"code":"Sx00-1015-316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050834","type":"LOCAL"},{"code":"405712","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050834 = Hospital System Supply Identifier | 405712 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5","code_information":[{"code":"Sx00-1015-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051019","type":"LOCAL"},{"code":"424925","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1051019 = Hospital System Supply Identifier | 424925 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X24MM","code_information":[{"code":"Sx00-1015-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050835","type":"LOCAL"},{"code":"405713","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050835 = Hospital System Supply Identifier | 405713 = Lawson ID"}]},{"description":"SCREW CANN 4.5X28MM","code_information":[{"code":"Sx00-1015-328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054301","type":"LOCAL"},{"code":"876751","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054301 = Hospital System Supply Identifier | 876751 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X32MM","code_information":[{"code":"Sx00-1015-332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821527","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821527 = Hospital System Supply Identifier"}]},{"description":"SCREW CANN PED-PLT 4.5X36MM","code_information":[{"code":"Sx00-1015-336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050836","type":"LOCAL"},{"code":"405715","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050836 = Hospital System Supply Identifier | 405715 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 16MM","code_information":[{"code":"Sx00-1015-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833247","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833247 = Hospital System Supply Identifier"}]},{"description":"PLATE PEDI I W/HLDR 22MM","code_information":[{"code":"Sx00-1015-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833245","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833245 = Hospital System Supply Identifier"}]},{"description":"PLATE PEDI I W/HLDR 32MM","code_information":[{"code":"Sx00-1015-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050837","type":"LOCAL"},{"code":"410078","type":"LOCAL"}],"standard_charges":[{"gross_charge":1635.36,"discounted_cash":1226.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050837 = Hospital System Supply Identifier | 410078 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X16MM","code_information":[{"code":"Sx00-1015-516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054302","type":"LOCAL"},{"code":"876752","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054302 = Hospital System Supply Identifier | 876752 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X20MM","code_information":[{"code":"Sx00-1015-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054303","type":"LOCAL"},{"code":"876753","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054303 = Hospital System Supply Identifier | 876753 = Lawson ID"}]},{"description":"SCREW BONE 244.5PEDIATRIC CANC","code_information":[{"code":"Sx00-1015-524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939746","type":"LOCAL"},{"code":"824274","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939746 = Hospital System Supply Identifier | 824274 = Lawson ID"}]},{"description":"SCREW BONE 284.5SELF TAP LOW P","code_information":[{"code":"Sx00-1015-528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939745","type":"LOCAL"},{"code":"824273","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939745 = Hospital System Supply Identifier | 824273 = Lawson ID"}]},{"description":"SCREW BONE 324.5LOW PROFILE SO","code_information":[{"code":"Sx00-1015-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939744","type":"LOCAL"},{"code":"824272","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939744 = Hospital System Supply Identifier | 824272 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X36MM","code_information":[{"code":"Sx00-1015-536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054304","type":"LOCAL"},{"code":"876754","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054304 = Hospital System Supply Identifier | 876754 = Lawson ID"}]},{"description":"SCREW BONE 164.5CANN LOW PROFI","code_information":[{"code":"Sx00-1015-616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942930","type":"LOCAL"},{"code":"827490","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 942930 = Hospital System Supply Identifier | 827490 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X20MM","code_information":[{"code":"Sx00-1015-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"802570","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 802570 = Hospital System Supply Identifier"}]},{"description":"SCREW CANN LP 4.5X24MM","code_information":[{"code":"Sx00-1015-624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"892141","type":"LOCAL"},{"code":"536297","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 892141 = Hospital System Supply Identifier | 536297 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X28MM","code_information":[{"code":"Sx00-1015-628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"887630","type":"LOCAL"},{"code":"461781","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 887630 = Hospital System Supply Identifier | 461781 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X32MM","code_information":[{"code":"Sx00-1015-632","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"835986","type":"LOCAL"},{"code":"461782","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 835986 = Hospital System Supply Identifier | 461782 = Lawson ID"}]},{"description":"SCREW BONE 364.5FEMORAL PHYSEA","code_information":[{"code":"Sx00-1015-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939471","type":"LOCAL"},{"code":"823995","type":"LOCAL"}],"standard_charges":[{"gross_charge":805.47,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 939471 = Hospital System Supply Identifier | 823995 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054305","type":"LOCAL"},{"code":"876755","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054305 = Hospital System Supply Identifier | 876755 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054308","type":"LOCAL"},{"code":"876758","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054308 = Hospital System Supply Identifier | 876758 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054307","type":"LOCAL"},{"code":"876757","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054307 = Hospital System Supply Identifier | 876757 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054306","type":"LOCAL"},{"code":"876756","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054306 = Hospital System Supply Identifier | 876756 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054309","type":"LOCAL"},{"code":"876759","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054309 = Hospital System Supply Identifier | 876759 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054310","type":"LOCAL"},{"code":"876760","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054310 = Hospital System Supply Identifier | 876760 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054311","type":"LOCAL"},{"code":"876761","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054311 = Hospital System Supply Identifier | 876761 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054312","type":"LOCAL"},{"code":"876762","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054312 = Hospital System Supply Identifier | 876762 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054313","type":"LOCAL"},{"code":"876763","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054313 = Hospital System Supply Identifier | 876763 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054314","type":"LOCAL"},{"code":"876764","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054314 = Hospital System Supply Identifier | 876764 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054315","type":"LOCAL"},{"code":"876765","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054315 = Hospital System Supply Identifier | 876765 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054316","type":"LOCAL"},{"code":"876766","type":"LOCAL"}],"standard_charges":[{"gross_charge":580.15,"discounted_cash":435.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054316 = Hospital System Supply Identifier | 876766 = Lawson ID"}]},{"description":"O-PLATE TI 12MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054317","type":"LOCAL"},{"code":"876767","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054317 = Hospital System Supply Identifier | 876767 = Lawson ID"}]},{"description":"O-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054318","type":"LOCAL"},{"code":"876768","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054318 = Hospital System Supply Identifier | 876768 = Lawson ID"}]},{"description":"O-PLATE TI 24MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054320","type":"LOCAL"},{"code":"876770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054320 = Hospital System Supply Identifier | 876770 = Lawson ID"}]},{"description":"O-PLATE TI 20MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054319","type":"LOCAL"},{"code":"876769","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054319 = Hospital System Supply Identifier | 876769 = Lawson ID"}]},{"description":"I-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054321","type":"LOCAL"},{"code":"876771","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054321 = Hospital System Supply Identifier | 876771 = Lawson ID"}]},{"description":"I-PLATE TI 22MM","code_information":[{"code":"Sx00-1015-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054322","type":"LOCAL"},{"code":"876772","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054322 = Hospital System Supply Identifier | 876772 = Lawson ID"}]},{"description":"I-PLATE TI 32MM","code_information":[{"code":"Sx00-1015-843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054323","type":"LOCAL"},{"code":"876773","type":"LOCAL"}],"standard_charges":[{"gross_charge":2150.4,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054323 = Hospital System Supply Identifier | 876773 = Lawson ID"}]},{"description":"WASHER","code_information":[{"code":"Sx00-1030-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054324","type":"LOCAL"},{"code":"876774","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054324 = Hospital System Supply Identifier | 876774 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054325","type":"LOCAL"},{"code":"876775","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054325 = Hospital System Supply Identifier | 876775 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054326","type":"LOCAL"},{"code":"876776","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054326 = Hospital System Supply Identifier | 876776 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054327","type":"LOCAL"},{"code":"876777","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054327 = Hospital System Supply Identifier | 876777 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054328","type":"LOCAL"},{"code":"876778","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054328 = Hospital System Supply Identifier | 876778 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054329","type":"LOCAL"},{"code":"876779","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054329 = Hospital System Supply Identifier | 876779 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054330","type":"LOCAL"},{"code":"876780","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054330 = Hospital System Supply Identifier | 876780 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054331","type":"LOCAL"},{"code":"876781","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054331 = Hospital System Supply Identifier | 876781 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054332","type":"LOCAL"},{"code":"876782","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054332 = Hospital System Supply Identifier | 876782 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054333","type":"LOCAL"},{"code":"876783","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054333 = Hospital System Supply Identifier | 876783 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054334","type":"LOCAL"},{"code":"876784","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054334 = Hospital System Supply Identifier | 876784 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054335","type":"LOCAL"},{"code":"876785","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054335 = Hospital System Supply Identifier | 876785 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054336","type":"LOCAL"},{"code":"876786","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054336 = Hospital System Supply Identifier | 876786 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054337","type":"LOCAL"},{"code":"876787","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054337 = Hospital System Supply Identifier | 876787 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054338","type":"LOCAL"},{"code":"876788","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054338 = Hospital System Supply Identifier | 876788 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054339","type":"LOCAL"},{"code":"876789","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054339 = Hospital System Supply Identifier | 876789 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054340","type":"LOCAL"},{"code":"876790","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054340 = Hospital System Supply Identifier | 876790 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054341","type":"LOCAL"},{"code":"876791","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054341 = Hospital System Supply Identifier | 876791 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054342","type":"LOCAL"},{"code":"876792","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054342 = Hospital System Supply Identifier | 876792 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054343","type":"LOCAL"},{"code":"876793","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054343 = Hospital System Supply Identifier | 876793 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054344","type":"LOCAL"},{"code":"876794","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054344 = Hospital System Supply Identifier | 876794 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054345","type":"LOCAL"},{"code":"876795","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054345 = Hospital System Supply Identifier | 876795 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054346","type":"LOCAL"},{"code":"876796","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054346 = Hospital System Supply Identifier | 876796 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054347","type":"LOCAL"},{"code":"876797","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054347 = Hospital System Supply Identifier | 876797 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054348","type":"LOCAL"},{"code":"876798","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054348 = Hospital System Supply Identifier | 876798 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X35MM","code_information":[{"code":"Sx00-1030-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054349","type":"LOCAL"},{"code":"876799","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054349 = Hospital System Supply Identifier | 876799 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054350","type":"LOCAL"},{"code":"876800","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054350 = Hospital System Supply Identifier | 876800 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X45MM","code_information":[{"code":"Sx00-1030-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054351","type":"LOCAL"},{"code":"876801","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054351 = Hospital System Supply Identifier | 876801 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054352","type":"LOCAL"},{"code":"876802","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054352 = Hospital System Supply Identifier | 876802 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X55MM","code_information":[{"code":"Sx00-1030-155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054353","type":"LOCAL"},{"code":"876803","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054353 = Hospital System Supply Identifier | 876803 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054354","type":"LOCAL"},{"code":"876804","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054354 = Hospital System Supply Identifier | 876804 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054355","type":"LOCAL"},{"code":"876805","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054355 = Hospital System Supply Identifier | 876805 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054356","type":"LOCAL"},{"code":"876806","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054356 = Hospital System Supply Identifier | 876806 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X10MM","code_information":[{"code":"Sx00-1030-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054357","type":"LOCAL"},{"code":"876807","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054357 = Hospital System Supply Identifier | 876807 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X12MM","code_information":[{"code":"Sx00-1030-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054358","type":"LOCAL"},{"code":"876808","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054358 = Hospital System Supply Identifier | 876808 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X14MM","code_information":[{"code":"Sx00-1030-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054359","type":"LOCAL"},{"code":"876809","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054359 = Hospital System Supply Identifier | 876809 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X16MM","code_information":[{"code":"Sx00-1030-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054360","type":"LOCAL"},{"code":"876810","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054360 = Hospital System Supply Identifier | 876810 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X18MM","code_information":[{"code":"Sx00-1030-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054361","type":"LOCAL"},{"code":"876811","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054361 = Hospital System Supply Identifier | 876811 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054362","type":"LOCAL"},{"code":"876812","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054362 = Hospital System Supply Identifier | 876812 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054363","type":"LOCAL"},{"code":"876813","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054363 = Hospital System Supply Identifier | 876813 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054364","type":"LOCAL"},{"code":"876814","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054364 = Hospital System Supply Identifier | 876814 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054365","type":"LOCAL"},{"code":"876815","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054365 = Hospital System Supply Identifier | 876815 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054366","type":"LOCAL"},{"code":"876816","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054366 = Hospital System Supply Identifier | 876816 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054367","type":"LOCAL"},{"code":"876817","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054367 = Hospital System Supply Identifier | 876817 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054368","type":"LOCAL"},{"code":"876818","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054368 = Hospital System Supply Identifier | 876818 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054369","type":"LOCAL"},{"code":"876819","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054369 = Hospital System Supply Identifier | 876819 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054370","type":"LOCAL"},{"code":"876820","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054370 = Hospital System Supply Identifier | 876820 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054371","type":"LOCAL"},{"code":"876821","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054371 = Hospital System Supply Identifier | 876821 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054372","type":"LOCAL"},{"code":"876822","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054372 = Hospital System Supply Identifier | 876822 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054373","type":"LOCAL"},{"code":"876823","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054373 = Hospital System Supply Identifier | 876823 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054374","type":"LOCAL"},{"code":"876824","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054374 = Hospital System Supply Identifier | 876824 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054375","type":"LOCAL"},{"code":"876825","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054375 = Hospital System Supply Identifier | 876825 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054376","type":"LOCAL"},{"code":"876826","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054376 = Hospital System Supply Identifier | 876826 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054377","type":"LOCAL"},{"code":"876827","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054377 = Hospital System Supply Identifier | 876827 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054378","type":"LOCAL"},{"code":"876828","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054378 = Hospital System Supply Identifier | 876828 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054379","type":"LOCAL"},{"code":"876829","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054379 = Hospital System Supply Identifier | 876829 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054380","type":"LOCAL"},{"code":"876830","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054380 = Hospital System Supply Identifier | 876830 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054381","type":"LOCAL"},{"code":"876831","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054381 = Hospital System Supply Identifier | 876831 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054382","type":"LOCAL"},{"code":"876832","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054382 = Hospital System Supply Identifier | 876832 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054383","type":"LOCAL"},{"code":"876833","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054383 = Hospital System Supply Identifier | 876833 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054384","type":"LOCAL"},{"code":"876834","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054384 = Hospital System Supply Identifier | 876834 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 03MM","code_information":[{"code":"Sx00-104-19-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"92839","type":"LOCAL"},{"code":"144792","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 92839 = Hospital System Supply Identifier | 144792 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 05MM","code_information":[{"code":"Sx00-104-20-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"205625","type":"LOCAL"},{"code":"144793","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 205625 = Hospital System Supply Identifier | 144793 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 07MM","code_information":[{"code":"Sx00-104-21-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"205626","type":"LOCAL"},{"code":"144794","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 205626 = Hospital System Supply Identifier | 144794 = Lawson ID"}]},{"description":"PLATE CHIN GRIFFIN 9MM ADV","code_information":[{"code":"Sx00-104-22-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"192176","type":"LOCAL"},{"code":"232039","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 192176 = Hospital System Supply Identifier | 232039 = Lawson ID"}]},{"description":"PLATE LVL1 ORTHOG GRIFFIN","code_information":[{"code":"Sx00-104-23-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700425","type":"LOCAL"},{"code":"723561","type":"LOCAL"}],"standard_charges":[{"gross_charge":467.62,"discounted_cash":350.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 700425 = Hospital System Supply Identifier | 723561 = Lawson ID"}]},{"description":"DRILL TWIST MIDAS REX 1.0 X5MM","code_information":[{"code":"Sx00-104-49-0","type":"CDM"},{"code":"272","type":"RC"},{"code":"157623","type":"LOCAL"},{"code":"310249","type":"LOCAL"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 157623 = Hospital System Supply Identifier | 310249 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-105-49-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779932","type":"LOCAL"},{"code":"773377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1133.21,"discounted_cash":849.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 779932 = Hospital System Supply Identifier | 773377 = Lawson ID"}]},{"description":"PLATE LVL1 MINI BAYS T-SHP 4HL","code_information":[{"code":"Sx00-105-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700557","type":"LOCAL"},{"code":"723693","type":"LOCAL"}],"standard_charges":[{"gross_charge":372.54,"discounted_cash":279.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 700557 = Hospital System Supply Identifier | 723693 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 8H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050849","type":"LOCAL"},{"code":"414030","type":"LOCAL"}],"standard_charges":[{"gross_charge":439.5,"discounted_cash":329.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050849 = Hospital System Supply Identifier | 414030 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 5H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050847","type":"LOCAL"},{"code":"414028","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050847 = Hospital System Supply Identifier | 414028 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 7H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050848","type":"LOCAL"},{"code":"414029","type":"LOCAL"}],"standard_charges":[{"gross_charge":424.85,"discounted_cash":318.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050848 = Hospital System Supply Identifier | 414029 = Lawson ID"}]},{"description":"PLATE LOK TBLR 1/3 6H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050838","type":"LOCAL"},{"code":"410079","type":"LOCAL"}],"standard_charges":[{"gross_charge":410.2,"discounted_cash":307.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050838 = Hospital System Supply Identifier | 410079 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 4H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050846","type":"LOCAL"},{"code":"414027","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":285.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050846 = Hospital System Supply Identifier | 414027 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 10H","code_information":[{"code":"Sx00-1050-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050850","type":"LOCAL"},{"code":"414031","type":"LOCAL"}],"standard_charges":[{"gross_charge":454.15,"discounted_cash":340.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050850 = Hospital System Supply Identifier | 414031 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 4H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050851","type":"LOCAL"},{"code":"414032","type":"LOCAL"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":636.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050851 = Hospital System Supply Identifier | 414032 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 6H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050852","type":"LOCAL"},{"code":"414033","type":"LOCAL"}],"standard_charges":[{"gross_charge":919.75,"discounted_cash":689.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050852 = Hospital System Supply Identifier | 414033 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 8H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050853","type":"LOCAL"},{"code":"414034","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":740.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050853 = Hospital System Supply Identifier | 414034 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 10H","code_information":[{"code":"Sx00-1050-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050854","type":"LOCAL"},{"code":"414035","type":"LOCAL"}],"standard_charges":[{"gross_charge":1057.5,"discounted_cash":793.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050854 = Hospital System Supply Identifier | 414035 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 8H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833243","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833243 = Hospital System Supply Identifier"}]},{"description":"PLATE COMPR LOK FEM 3.5 6H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051006","type":"LOCAL"},{"code":"414193","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1051006 = Hospital System Supply Identifier | 414193 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050857","type":"LOCAL"},{"code":"414038","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050857 = Hospital System Supply Identifier | 414038 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050856","type":"LOCAL"},{"code":"414037","type":"LOCAL"}],"standard_charges":[{"gross_charge":9203.26,"discounted_cash":6902.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050856 = Hospital System Supply Identifier | 414037 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING FEMORAL TITANIUM 18-HOLE","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357259","type":"LOCAL"},{"code":"1083572","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357259 = Hospital System Supply Identifier | 1083572 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050855","type":"LOCAL"},{"code":"414036","type":"LOCAL"}],"standard_charges":[{"gross_charge":9005.0,"discounted_cash":6753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050855 = Hospital System Supply Identifier | 414036 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 10H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"819438","type":"LOCAL"}],"standard_charges":[{"gross_charge":8806.74,"discounted_cash":6605.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 819438 = Hospital System Supply Identifier"}]},{"description":"PLATE COMPR LOK FEM 6H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050839","type":"LOCAL"},{"code":"410081","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050839 = Hospital System Supply Identifier | 410081 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 8H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050840","type":"LOCAL"},{"code":"410082","type":"LOCAL"}],"standard_charges":[{"gross_charge":8790.75,"discounted_cash":6593.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050840 = Hospital System Supply Identifier | 410082 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION LOCKING 18 HOLE PEDILOC 0010503118 3.5MM","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356461","type":"LOCAL"},{"code":"1083743","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356461 = Hospital System Supply Identifier | 1083743 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 10H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050858","type":"LOCAL"},{"code":"414040","type":"LOCAL"}],"standard_charges":[{"gross_charge":8806.74,"discounted_cash":6605.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050858 = Hospital System Supply Identifier | 414040 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050859","type":"LOCAL"},{"code":"414041","type":"LOCAL"}],"standard_charges":[{"gross_charge":9005.0,"discounted_cash":6753.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050859 = Hospital System Supply Identifier | 414041 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050860","type":"LOCAL"},{"code":"414042","type":"LOCAL"}],"standard_charges":[{"gross_charge":9203.26,"discounted_cash":6902.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050860 = Hospital System Supply Identifier | 414042 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050861","type":"LOCAL"},{"code":"414043","type":"LOCAL"}],"standard_charges":[{"gross_charge":10727.26,"discounted_cash":8045.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050861 = Hospital System Supply Identifier | 414043 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 18H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050865","type":"LOCAL"},{"code":"414048","type":"LOCAL"}],"standard_charges":[{"gross_charge":8113.86,"discounted_cash":6085.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050865 = Hospital System Supply Identifier | 414048 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 16H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050864","type":"LOCAL"},{"code":"414047","type":"LOCAL"}],"standard_charges":[{"gross_charge":7860.31,"discounted_cash":5895.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050864 = Hospital System Supply Identifier | 414047 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 10H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050862","type":"LOCAL"},{"code":"414045","type":"LOCAL"}],"standard_charges":[{"gross_charge":6010.51,"discounted_cash":4507.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050862 = Hospital System Supply Identifier | 414045 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 14H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050841","type":"LOCAL"},{"code":"410083","type":"LOCAL"}],"standard_charges":[{"gross_charge":6703.73,"discounted_cash":5027.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050841 = Hospital System Supply Identifier | 410083 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 12H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050863","type":"LOCAL"},{"code":"414046","type":"LOCAL"}],"standard_charges":[{"gross_charge":6223.74,"discounted_cash":4667.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050863 = Hospital System Supply Identifier | 414046 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 4H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050866","type":"LOCAL"},{"code":"414049","type":"LOCAL"}],"standard_charges":[{"gross_charge":290.94,"discounted_cash":218.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050866 = Hospital System Supply Identifier | 414049 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 5H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050867","type":"LOCAL"},{"code":"414050","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.48,"discounted_cash":227.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050867 = Hospital System Supply Identifier | 414050 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 6H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050868","type":"LOCAL"},{"code":"414051","type":"LOCAL"}],"standard_charges":[{"gross_charge":303.48,"discounted_cash":227.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050868 = Hospital System Supply Identifier | 414051 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 7H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050869","type":"LOCAL"},{"code":"414052","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.02,"discounted_cash":237.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050869 = Hospital System Supply Identifier | 414052 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 8H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050870","type":"LOCAL"},{"code":"414053","type":"LOCAL"}],"standard_charges":[{"gross_charge":316.02,"discounted_cash":237.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050870 = Hospital System Supply Identifier | 414053 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 10H","code_information":[{"code":"Sx00-1050-341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050871","type":"LOCAL"},{"code":"414054","type":"LOCAL"}],"standard_charges":[{"gross_charge":360.3,"discounted_cash":270.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050871 = Hospital System Supply Identifier | 414054 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X12","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050873","type":"LOCAL"},{"code":"414056","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050873 = Hospital System Supply Identifier | 414056 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X14","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050874","type":"LOCAL"},{"code":"414057","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050874 = Hospital System Supply Identifier | 414057 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X18","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050833","type":"LOCAL"},{"code":"402529","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050833 = Hospital System Supply Identifier | 402529 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X16","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050832","type":"LOCAL"},{"code":"402528","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050832 = Hospital System Supply Identifier | 402528 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X10","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050872","type":"LOCAL"},{"code":"414055","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050872 = Hospital System Supply Identifier | 414055 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X20","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821159","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821159 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X26","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821174","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821174 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X22","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050717","type":"LOCAL"},{"code":"399821","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050717 = Hospital System Supply Identifier | 399821 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X24","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050718","type":"LOCAL"},{"code":"399822","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050718 = Hospital System Supply Identifier | 399822 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X28","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050719","type":"LOCAL"},{"code":"399824","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050719 = Hospital System Supply Identifier | 399824 = Lawson ID"}]},{"description":"SCREW CORT NLOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051020","type":"LOCAL"},{"code":"431449","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1051020 = Hospital System Supply Identifier | 431449 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X36","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050720","type":"LOCAL"},{"code":"399828","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050720 = Hospital System Supply Identifier | 399828 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X32","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833237","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833237 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X30","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833236","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833236 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X34","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833238","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833238 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X42","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050876","type":"LOCAL"},{"code":"414059","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050876 = Hospital System Supply Identifier | 414059 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X46","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833239","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833239 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X48","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050721","type":"LOCAL"},{"code":"399829","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050721 = Hospital System Supply Identifier | 399829 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X40","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050875","type":"LOCAL"},{"code":"414058","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050875 = Hospital System Supply Identifier | 414058 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X44","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050877","type":"LOCAL"},{"code":"414060","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050877 = Hospital System Supply Identifier | 414060 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X52","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050879","type":"LOCAL"},{"code":"414063","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050879 = Hospital System Supply Identifier | 414063 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X58","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050882","type":"LOCAL"},{"code":"414066","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050882 = Hospital System Supply Identifier | 414066 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X56","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050881","type":"LOCAL"},{"code":"414065","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050881 = Hospital System Supply Identifier | 414065 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X50","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050878","type":"LOCAL"},{"code":"414062","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050878 = Hospital System Supply Identifier | 414062 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X54","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050880","type":"LOCAL"},{"code":"414064","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050880 = Hospital System Supply Identifier | 414064 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X60","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833240","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833240 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X65","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833241","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833241 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X70","code_information":[{"code":"Sx00-1050-357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050883","type":"LOCAL"},{"code":"414069","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050883 = Hospital System Supply Identifier | 414069 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X12MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050722","type":"LOCAL"},{"code":"399830","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050722 = Hospital System Supply Identifier | 399830 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X16MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"880906","type":"LOCAL"},{"code":"399831","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 880906 = Hospital System Supply Identifier | 399831 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X18MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050723","type":"LOCAL"},{"code":"399832","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050723 = Hospital System Supply Identifier | 399832 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X10MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050884","type":"LOCAL"},{"code":"414070","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050884 = Hospital System Supply Identifier | 414070 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X14MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050885","type":"LOCAL"},{"code":"414071","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050885 = Hospital System Supply Identifier | 414071 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X22MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821164","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821164 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT LOK FT 3.5X28MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821181","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821181 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT LOK FT 3.5X20MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050724","type":"LOCAL"},{"code":"399833","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050724 = Hospital System Supply Identifier | 399833 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X24MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050725","type":"LOCAL"},{"code":"399835","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050725 = Hospital System Supply Identifier | 399835 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X26MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050726","type":"LOCAL"},{"code":"399836","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050726 = Hospital System Supply Identifier | 399836 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050886","type":"LOCAL"},{"code":"414072","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050886 = Hospital System Supply Identifier | 414072 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X36MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050729","type":"LOCAL"},{"code":"399841","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050729 = Hospital System Supply Identifier | 399841 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X34MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050728","type":"LOCAL"},{"code":"399840","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050728 = Hospital System Supply Identifier | 399840 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X32MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050727","type":"LOCAL"},{"code":"399839","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050727 = Hospital System Supply Identifier | 399839 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X30MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821186","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 821186 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT LOK FT 3.5X40MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050730","type":"LOCAL"},{"code":"399842","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050730 = Hospital System Supply Identifier | 399842 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X42MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050731","type":"LOCAL"},{"code":"399843","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050731 = Hospital System Supply Identifier | 399843 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X44MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050732","type":"LOCAL"},{"code":"399844","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050732 = Hospital System Supply Identifier | 399844 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X46MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050733","type":"LOCAL"},{"code":"399845","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050733 = Hospital System Supply Identifier | 399845 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X48MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050734","type":"LOCAL"},{"code":"399846","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050734 = Hospital System Supply Identifier | 399846 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X54MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833242","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 833242 = Hospital System Supply Identifier"}]},{"description":"SCREW PED CORT LOK FT 3.5X52MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050735","type":"LOCAL"},{"code":"399847","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050735 = Hospital System Supply Identifier | 399847 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X58MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050736","type":"LOCAL"},{"code":"399848","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050736 = Hospital System Supply Identifier | 399848 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X50MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050887","type":"LOCAL"},{"code":"414073","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050887 = Hospital System Supply Identifier | 414073 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X56MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050888","type":"LOCAL"},{"code":"414075","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050888 = Hospital System Supply Identifier | 414075 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X60MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050889","type":"LOCAL"},{"code":"414076","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050889 = Hospital System Supply Identifier | 414076 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X65MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050890","type":"LOCAL"},{"code":"414077","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050890 = Hospital System Supply Identifier | 414077 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X70MM","code_information":[{"code":"Sx00-1050-367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050891","type":"LOCAL"},{"code":"414078","type":"LOCAL"}],"standard_charges":[{"gross_charge":395.55,"discounted_cash":296.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050891 = Hospital System Supply Identifier | 414078 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X14","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050894","type":"LOCAL"},{"code":"414081","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050894 = Hospital System Supply Identifier | 414081 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X16","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050895","type":"LOCAL"},{"code":"414082","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050895 = Hospital System Supply Identifier | 414082 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X10","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050892","type":"LOCAL"},{"code":"414079","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050892 = Hospital System Supply Identifier | 414079 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X12","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050893","type":"LOCAL"},{"code":"414080","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050893 = Hospital System Supply Identifier | 414080 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X18","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050896","type":"LOCAL"},{"code":"414083","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050896 = Hospital System Supply Identifier | 414083 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X28","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050901","type":"LOCAL"},{"code":"414088","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050901 = Hospital System Supply Identifier | 414088 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X26","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050900","type":"LOCAL"},{"code":"414087","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050900 = Hospital System Supply Identifier | 414087 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X20","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050897","type":"LOCAL"},{"code":"414084","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050897 = Hospital System Supply Identifier | 414084 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X22","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050898","type":"LOCAL"},{"code":"414085","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050898 = Hospital System Supply Identifier | 414085 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X24","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050899","type":"LOCAL"},{"code":"414086","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050899 = Hospital System Supply Identifier | 414086 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X30","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050902","type":"LOCAL"},{"code":"414089","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050902 = Hospital System Supply Identifier | 414089 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X32","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050903","type":"LOCAL"},{"code":"414090","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050903 = Hospital System Supply Identifier | 414090 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X34","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050904","type":"LOCAL"},{"code":"414091","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050904 = Hospital System Supply Identifier | 414091 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X36","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050905","type":"LOCAL"},{"code":"414092","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050905 = Hospital System Supply Identifier | 414092 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X38","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050906","type":"LOCAL"},{"code":"414093","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050906 = Hospital System Supply Identifier | 414093 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X48","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050911","type":"LOCAL"},{"code":"414098","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050911 = Hospital System Supply Identifier | 414098 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X44","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050909","type":"LOCAL"},{"code":"414096","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050909 = Hospital System Supply Identifier | 414096 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X46","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050910","type":"LOCAL"},{"code":"414097","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050910 = Hospital System Supply Identifier | 414097 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X40","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050907","type":"LOCAL"},{"code":"414094","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050907 = Hospital System Supply Identifier | 414094 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X42","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050908","type":"LOCAL"},{"code":"414095","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050908 = Hospital System Supply Identifier | 414095 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X50","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050912","type":"LOCAL"},{"code":"414099","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050912 = Hospital System Supply Identifier | 414099 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X52","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050913","type":"LOCAL"},{"code":"414100","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050913 = Hospital System Supply Identifier | 414100 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X54","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050914","type":"LOCAL"},{"code":"414101","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050914 = Hospital System Supply Identifier | 414101 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X56","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050915","type":"LOCAL"},{"code":"414102","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050915 = Hospital System Supply Identifier | 414102 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X58","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050916","type":"LOCAL"},{"code":"414103","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050916 = Hospital System Supply Identifier | 414103 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X60","code_information":[{"code":"Sx00-1050-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050917","type":"LOCAL"},{"code":"414104","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050917 = Hospital System Supply Identifier | 414104 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X18","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050922","type":"LOCAL"},{"code":"414109","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050922 = Hospital System Supply Identifier | 414109 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X16","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050921","type":"LOCAL"},{"code":"414108","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050921 = Hospital System Supply Identifier | 414108 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X14","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050920","type":"LOCAL"},{"code":"414107","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050920 = Hospital System Supply Identifier | 414107 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X12","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050919","type":"LOCAL"},{"code":"414106","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050919 = Hospital System Supply Identifier | 414106 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X10","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050918","type":"LOCAL"},{"code":"414105","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050918 = Hospital System Supply Identifier | 414105 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X20","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050923","type":"LOCAL"},{"code":"414110","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050923 = Hospital System Supply Identifier | 414110 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X22","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050924","type":"LOCAL"},{"code":"414111","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050924 = Hospital System Supply Identifier | 414111 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X24","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050925","type":"LOCAL"},{"code":"414112","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050925 = Hospital System Supply Identifier | 414112 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X26","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050926","type":"LOCAL"},{"code":"414113","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050926 = Hospital System Supply Identifier | 414113 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X28","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050927","type":"LOCAL"},{"code":"414114","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050927 = Hospital System Supply Identifier | 414114 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X38","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050932","type":"LOCAL"},{"code":"414119","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050932 = Hospital System Supply Identifier | 414119 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X36","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050931","type":"LOCAL"},{"code":"414118","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050931 = Hospital System Supply Identifier | 414118 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X32","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050929","type":"LOCAL"},{"code":"414116","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050929 = Hospital System Supply Identifier | 414116 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X30","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050928","type":"LOCAL"},{"code":"414115","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050928 = Hospital System Supply Identifier | 414115 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X34","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050930","type":"LOCAL"},{"code":"414117","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050930 = Hospital System Supply Identifier | 414117 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X48","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050937","type":"LOCAL"},{"code":"414124","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050937 = Hospital System Supply Identifier | 414124 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X40","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050933","type":"LOCAL"},{"code":"414120","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050933 = Hospital System Supply Identifier | 414120 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X42","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050934","type":"LOCAL"},{"code":"414121","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050934 = Hospital System Supply Identifier | 414121 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X44","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050935","type":"LOCAL"},{"code":"414122","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050935 = Hospital System Supply Identifier | 414122 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X46","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050936","type":"LOCAL"},{"code":"414123","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050936 = Hospital System Supply Identifier | 414123 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X58","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050942","type":"LOCAL"},{"code":"414129","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050942 = Hospital System Supply Identifier | 414129 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X56","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050941","type":"LOCAL"},{"code":"414128","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050941 = Hospital System Supply Identifier | 414128 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X54","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050940","type":"LOCAL"},{"code":"414127","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050940 = Hospital System Supply Identifier | 414127 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X52","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050939","type":"LOCAL"},{"code":"414126","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050939 = Hospital System Supply Identifier | 414126 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X50","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050938","type":"LOCAL"},{"code":"414125","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050938 = Hospital System Supply Identifier | 414125 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X60","code_information":[{"code":"Sx00-1050-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050943","type":"LOCAL"},{"code":"414130","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050943 = Hospital System Supply Identifier | 414130 = Lawson ID"}]},{"description":"PLATE PEDI COMP FEM 4.5MM 6H","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050842","type":"LOCAL"},{"code":"410084","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050842 = Hospital System Supply Identifier | 410084 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.52 8H RT","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050944","type":"LOCAL"},{"code":"414131","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050944 = Hospital System Supply Identifier | 414131 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 16H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050948","type":"LOCAL"},{"code":"414135","type":"LOCAL"}],"standard_charges":[{"gross_charge":11560.43,"discounted_cash":8670.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050948 = Hospital System Supply Identifier | 414135 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 14H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050947","type":"LOCAL"},{"code":"414134","type":"LOCAL"}],"standard_charges":[{"gross_charge":11325.54,"discounted_cash":8494.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050947 = Hospital System Supply Identifier | 414134 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050949","type":"LOCAL"},{"code":"414136","type":"LOCAL"}],"standard_charges":[{"gross_charge":12493.65,"discounted_cash":9370.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050949 = Hospital System Supply Identifier | 414136 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050945","type":"LOCAL"},{"code":"414132","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050945 = Hospital System Supply Identifier | 414132 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050946","type":"LOCAL"},{"code":"414133","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050946 = Hospital System Supply Identifier | 414133 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H RT","code_information":[{"code":"Sx00-1050-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050950","type":"LOCAL"},{"code":"414137","type":"LOCAL"}],"standard_charges":[{"gross_charge":13017.39,"discounted_cash":9763.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050950 = Hospital System Supply Identifier | 414137 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 6H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050951","type":"LOCAL"},{"code":"414138","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050951 = Hospital System Supply Identifier | 414138 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 8H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050952","type":"LOCAL"},{"code":"414139","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050952 = Hospital System Supply Identifier | 414139 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050843","type":"LOCAL"},{"code":"410085","type":"LOCAL"}],"standard_charges":[{"gross_charge":11325.54,"discounted_cash":8494.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050843 = Hospital System Supply Identifier | 410085 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050844","type":"LOCAL"},{"code":"410086","type":"LOCAL"}],"standard_charges":[{"gross_charge":11560.43,"discounted_cash":8670.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050844 = Hospital System Supply Identifier | 410086 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050953","type":"LOCAL"},{"code":"414140","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050953 = Hospital System Supply Identifier | 414140 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050954","type":"LOCAL"},{"code":"414141","type":"LOCAL"}],"standard_charges":[{"gross_charge":11074.78,"discounted_cash":8306.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050954 = Hospital System Supply Identifier | 414141 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050955","type":"LOCAL"},{"code":"414142","type":"LOCAL"}],"standard_charges":[{"gross_charge":12493.65,"discounted_cash":9370.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050955 = Hospital System Supply Identifier | 414142 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H LT","code_information":[{"code":"Sx00-1050-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050956","type":"LOCAL"},{"code":"414143","type":"LOCAL"}],"standard_charges":[{"gross_charge":13017.39,"discounted_cash":9763.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050956 = Hospital System Supply Identifier | 414143 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 18H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050960","type":"LOCAL"},{"code":"414147","type":"LOCAL"}],"standard_charges":[{"gross_charge":8320.67,"discounted_cash":6240.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050960 = Hospital System Supply Identifier | 414147 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050959","type":"LOCAL"},{"code":"414146","type":"LOCAL"}],"standard_charges":[{"gross_charge":7998.32,"discounted_cash":5998.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050959 = Hospital System Supply Identifier | 414146 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 10H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050845","type":"LOCAL"},{"code":"410087","type":"LOCAL"}],"standard_charges":[{"gross_charge":6223.74,"discounted_cash":4667.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050845 = Hospital System Supply Identifier | 410087 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 12H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050957","type":"LOCAL"},{"code":"414144","type":"LOCAL"}],"standard_charges":[{"gross_charge":6458.9,"discounted_cash":4844.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050957 = Hospital System Supply Identifier | 414144 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050958","type":"LOCAL"},{"code":"414145","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.14,"discounted_cash":5100.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050958 = Hospital System Supply Identifier | 414145 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X10","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050961","type":"LOCAL"},{"code":"414148","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050961 = Hospital System Supply Identifier | 414148 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X12","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050962","type":"LOCAL"},{"code":"414149","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050962 = Hospital System Supply Identifier | 414149 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X14","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050963","type":"LOCAL"},{"code":"414150","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050963 = Hospital System Supply Identifier | 414150 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X16","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050964","type":"LOCAL"},{"code":"414151","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050964 = Hospital System Supply Identifier | 414151 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X18","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050965","type":"LOCAL"},{"code":"414152","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050965 = Hospital System Supply Identifier | 414152 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X28","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050968","type":"LOCAL"},{"code":"414155","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050968 = Hospital System Supply Identifier | 414155 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X24","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050967","type":"LOCAL"},{"code":"414154","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050967 = Hospital System Supply Identifier | 414154 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X20","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050966","type":"LOCAL"},{"code":"414153","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050966 = Hospital System Supply Identifier | 414153 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X22","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050737","type":"LOCAL"},{"code":"399849","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050737 = Hospital System Supply Identifier | 399849 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X26","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050738","type":"LOCAL"},{"code":"399850","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050738 = Hospital System Supply Identifier | 399850 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X32","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050739","type":"LOCAL"},{"code":"399851","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050739 = Hospital System Supply Identifier | 399851 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X30","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050969","type":"LOCAL"},{"code":"414156","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050969 = Hospital System Supply Identifier | 414156 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X34","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050970","type":"LOCAL"},{"code":"414157","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050970 = Hospital System Supply Identifier | 414157 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X36","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050971","type":"LOCAL"},{"code":"414158","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050971 = Hospital System Supply Identifier | 414158 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X38","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050972","type":"LOCAL"},{"code":"414159","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050972 = Hospital System Supply Identifier | 414159 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X46","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050974","type":"LOCAL"},{"code":"414161","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050974 = Hospital System Supply Identifier | 414161 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X40","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050973","type":"LOCAL"},{"code":"414160","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050973 = Hospital System Supply Identifier | 414160 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X48","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050742","type":"LOCAL"},{"code":"399854","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050742 = Hospital System Supply Identifier | 399854 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X42","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050740","type":"LOCAL"},{"code":"399852","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050740 = Hospital System Supply Identifier | 399852 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X44","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050741","type":"LOCAL"},{"code":"399853","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050741 = Hospital System Supply Identifier | 399853 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X52","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050743","type":"LOCAL"},{"code":"399855","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050743 = Hospital System Supply Identifier | 399855 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X54","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050744","type":"LOCAL"},{"code":"399856","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050744 = Hospital System Supply Identifier | 399856 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X50","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050975","type":"LOCAL"},{"code":"414162","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050975 = Hospital System Supply Identifier | 414162 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X56","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050976","type":"LOCAL"},{"code":"414163","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050976 = Hospital System Supply Identifier | 414163 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X58","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050977","type":"LOCAL"},{"code":"414164","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050977 = Hospital System Supply Identifier | 414164 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X60","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050745","type":"LOCAL"},{"code":"399857","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050745 = Hospital System Supply Identifier | 399857 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X65","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050978","type":"LOCAL"},{"code":"414165","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050978 = Hospital System Supply Identifier | 414165 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X75","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050747","type":"LOCAL"},{"code":"399859","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050747 = Hospital System Supply Identifier | 399859 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X70","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050746","type":"LOCAL"},{"code":"399858","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050746 = Hospital System Supply Identifier | 399858 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X80","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050979","type":"LOCAL"},{"code":"414166","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050979 = Hospital System Supply Identifier | 414166 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X85","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050980","type":"LOCAL"},{"code":"414167","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050980 = Hospital System Supply Identifier | 414167 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X90","code_information":[{"code":"Sx00-1050-459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050981","type":"LOCAL"},{"code":"414168","type":"LOCAL"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":82.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050981 = Hospital System Supply Identifier | 414168 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X10","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050982","type":"LOCAL"},{"code":"414169","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050982 = Hospital System Supply Identifier | 414169 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X12","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050983","type":"LOCAL"},{"code":"414170","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050983 = Hospital System Supply Identifier | 414170 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X14","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050984","type":"LOCAL"},{"code":"414171","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050984 = Hospital System Supply Identifier | 414171 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X16","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050985","type":"LOCAL"},{"code":"414172","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050985 = Hospital System Supply Identifier | 414172 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X18","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050986","type":"LOCAL"},{"code":"414173","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050986 = Hospital System Supply Identifier | 414173 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X24","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050989","type":"LOCAL"},{"code":"414176","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050989 = Hospital System Supply Identifier | 414176 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X22","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050988","type":"LOCAL"},{"code":"414175","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050988 = Hospital System Supply Identifier | 414175 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X26MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050748","type":"LOCAL"},{"code":"399860","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050748 = Hospital System Supply Identifier | 399860 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X28MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050749","type":"LOCAL"},{"code":"399861","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050749 = Hospital System Supply Identifier | 399861 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X20","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050987","type":"LOCAL"},{"code":"414174","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050987 = Hospital System Supply Identifier | 414174 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X30MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050750","type":"LOCAL"},{"code":"399862","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050750 = Hospital System Supply Identifier | 399862 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X32MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050751","type":"LOCAL"},{"code":"399863","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050751 = Hospital System Supply Identifier | 399863 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X34MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050752","type":"LOCAL"},{"code":"399864","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050752 = Hospital System Supply Identifier | 399864 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X38MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050753","type":"LOCAL"},{"code":"399865","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050753 = Hospital System Supply Identifier | 399865 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X36","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050990","type":"LOCAL"},{"code":"414177","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050990 = Hospital System Supply Identifier | 414177 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X40","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050991","type":"LOCAL"},{"code":"414178","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050991 = Hospital System Supply Identifier | 414178 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X48MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050757","type":"LOCAL"},{"code":"399869","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050757 = Hospital System Supply Identifier | 399869 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X44MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050755","type":"LOCAL"},{"code":"399867","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050755 = Hospital System Supply Identifier | 399867 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X42MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050754","type":"LOCAL"},{"code":"399866","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050754 = Hospital System Supply Identifier | 399866 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X46MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050756","type":"LOCAL"},{"code":"399868","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050756 = Hospital System Supply Identifier | 399868 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X50","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050992","type":"LOCAL"},{"code":"414179","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050992 = Hospital System Supply Identifier | 414179 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X52MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050758","type":"LOCAL"},{"code":"399870","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050758 = Hospital System Supply Identifier | 399870 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X56MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050759","type":"LOCAL"},{"code":"399871","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050759 = Hospital System Supply Identifier | 399871 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X58MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050760","type":"LOCAL"},{"code":"399872","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050760 = Hospital System Supply Identifier | 399872 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X54","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050993","type":"LOCAL"},{"code":"414180","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050993 = Hospital System Supply Identifier | 414180 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X65MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050762","type":"LOCAL"},{"code":"399874","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050762 = Hospital System Supply Identifier | 399874 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X60MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050761","type":"LOCAL"},{"code":"399873","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050761 = Hospital System Supply Identifier | 399873 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X70","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050994","type":"LOCAL"},{"code":"414181","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050994 = Hospital System Supply Identifier | 414181 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X75","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050995","type":"LOCAL"},{"code":"414182","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050995 = Hospital System Supply Identifier | 414182 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X80","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050996","type":"LOCAL"},{"code":"414183","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050996 = Hospital System Supply Identifier | 414183 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X85","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050997","type":"LOCAL"},{"code":"414184","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050997 = Hospital System Supply Identifier | 414184 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X90","code_information":[{"code":"Sx00-1050-469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050998","type":"LOCAL"},{"code":"414185","type":"LOCAL"}],"standard_charges":[{"gross_charge":901.63,"discounted_cash":676.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1050998 = Hospital System Supply Identifier | 414185 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054385","type":"LOCAL"},{"code":"876835","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054385 = Hospital System Supply Identifier | 876835 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054386","type":"LOCAL"},{"code":"876836","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054386 = Hospital System Supply Identifier | 876836 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054387","type":"LOCAL"},{"code":"876837","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054387 = Hospital System Supply Identifier | 876837 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054388","type":"LOCAL"},{"code":"876838","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054388 = Hospital System Supply Identifier | 876838 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054390","type":"LOCAL"},{"code":"876840","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054390 = Hospital System Supply Identifier | 876840 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 4H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054389","type":"LOCAL"},{"code":"876839","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054389 = Hospital System Supply Identifier | 876839 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054391","type":"LOCAL"},{"code":"876841","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054391 = Hospital System Supply Identifier | 876841 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054392","type":"LOCAL"},{"code":"876842","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054392 = Hospital System Supply Identifier | 876842 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054393","type":"LOCAL"},{"code":"876843","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054393 = Hospital System Supply Identifier | 876843 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054394","type":"LOCAL"},{"code":"876844","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054394 = Hospital System Supply Identifier | 876844 = Lawson ID"}]},{"description":"PLATE BONE 4.5MM 90D DFOS 18D","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971153","type":"LOCAL"},{"code":"841865","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 971153 = Hospital System Supply Identifier | 841865 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054395","type":"LOCAL"},{"code":"876845","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054395 = Hospital System Supply Identifier | 876845 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054397","type":"LOCAL"},{"code":"876847","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054397 = Hospital System Supply Identifier | 876847 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054396","type":"LOCAL"},{"code":"876846","type":"LOCAL"}],"standard_charges":[{"gross_charge":9214.0,"discounted_cash":6910.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054396 = Hospital System Supply Identifier | 876846 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054399","type":"LOCAL"},{"code":"876849","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054399 = Hospital System Supply Identifier | 876849 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054398","type":"LOCAL"},{"code":"876848","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054398 = Hospital System Supply Identifier | 876848 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ4","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054400","type":"LOCAL"},{"code":"876850","type":"LOCAL"}],"standard_charges":[{"gross_charge":7789.53,"discounted_cash":5842.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054400 = Hospital System Supply Identifier | 876850 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ6","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054401","type":"LOCAL"},{"code":"876851","type":"LOCAL"}],"standard_charges":[{"gross_charge":7978.03,"discounted_cash":5983.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054401 = Hospital System Supply Identifier | 876851 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ8","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054402","type":"LOCAL"},{"code":"876852","type":"LOCAL"}],"standard_charges":[{"gross_charge":8134.06,"discounted_cash":6100.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054402 = Hospital System Supply Identifier | 876852 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ10","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054403","type":"LOCAL"},{"code":"876853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8321.86,"discounted_cash":6241.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054403 = Hospital System Supply Identifier | 876853 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ12","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054404","type":"LOCAL"},{"code":"876854","type":"LOCAL"}],"standard_charges":[{"gross_charge":8509.67,"discounted_cash":6382.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054404 = Hospital System Supply Identifier | 876854 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ14","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054405","type":"LOCAL"},{"code":"876855","type":"LOCAL"}],"standard_charges":[{"gross_charge":8697.47,"discounted_cash":6523.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054405 = Hospital System Supply Identifier | 876855 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ16","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054406","type":"LOCAL"},{"code":"876856","type":"LOCAL"}],"standard_charges":[{"gross_charge":10137.96,"discounted_cash":7603.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054406 = Hospital System Supply Identifier | 876856 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ4","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054407","type":"LOCAL"},{"code":"876857","type":"LOCAL"}],"standard_charges":[{"gross_charge":7789.53,"discounted_cash":5842.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054407 = Hospital System Supply Identifier | 876857 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ6","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054408","type":"LOCAL"},{"code":"876858","type":"LOCAL"}],"standard_charges":[{"gross_charge":7978.03,"discounted_cash":5983.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054408 = Hospital System Supply Identifier | 876858 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ8","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054409","type":"LOCAL"},{"code":"876859","type":"LOCAL"}],"standard_charges":[{"gross_charge":8134.06,"discounted_cash":6100.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054409 = Hospital System Supply Identifier | 876859 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ10","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054410","type":"LOCAL"},{"code":"876860","type":"LOCAL"}],"standard_charges":[{"gross_charge":8321.86,"discounted_cash":6241.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054410 = Hospital System Supply Identifier | 876860 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ12","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054411","type":"LOCAL"},{"code":"876861","type":"LOCAL"}],"standard_charges":[{"gross_charge":8509.67,"discounted_cash":6382.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054411 = Hospital System Supply Identifier | 876861 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ14","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054412","type":"LOCAL"},{"code":"876862","type":"LOCAL"}],"standard_charges":[{"gross_charge":8697.47,"discounted_cash":6523.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054412 = Hospital System Supply Identifier | 876862 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ16","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054413","type":"LOCAL"},{"code":"876863","type":"LOCAL"}],"standard_charges":[{"gross_charge":10137.96,"discounted_cash":7603.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054413 = Hospital System Supply Identifier | 876863 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 16HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054417","type":"LOCAL"},{"code":"876867","type":"LOCAL"}],"standard_charges":[{"gross_charge":7427.23,"discounted_cash":5570.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054417 = Hospital System Supply Identifier | 876867 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 14HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054416","type":"LOCAL"},{"code":"876866","type":"LOCAL"}],"standard_charges":[{"gross_charge":6334.14,"discounted_cash":4750.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054416 = Hospital System Supply Identifier | 876866 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 18HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054418","type":"LOCAL"},{"code":"876868","type":"LOCAL"}],"standard_charges":[{"gross_charge":7667.13,"discounted_cash":5750.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054418 = Hospital System Supply Identifier | 876868 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 10HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054414","type":"LOCAL"},{"code":"876864","type":"LOCAL"}],"standard_charges":[{"gross_charge":5679.19,"discounted_cash":4259.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054414 = Hospital System Supply Identifier | 876864 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 12HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054415","type":"LOCAL"},{"code":"876865","type":"LOCAL"}],"standard_charges":[{"gross_charge":5903.6,"discounted_cash":4427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054415 = Hospital System Supply Identifier | 876865 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ8","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054421","type":"LOCAL"},{"code":"876871","type":"LOCAL"}],"standard_charges":[{"gross_charge":9545.04,"discounted_cash":7158.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054421 = Hospital System Supply Identifier | 876871 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ4","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054419","type":"LOCAL"},{"code":"876869","type":"LOCAL"}],"standard_charges":[{"gross_charge":9114.54,"discounted_cash":6835.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054419 = Hospital System Supply Identifier | 876869 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ6","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054420","type":"LOCAL"},{"code":"876870","type":"LOCAL"}],"standard_charges":[{"gross_charge":9346.24,"discounted_cash":7009.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054420 = Hospital System Supply Identifier | 876870 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ10","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054422","type":"LOCAL"},{"code":"876872","type":"LOCAL"}],"standard_charges":[{"gross_charge":10264.32,"discounted_cash":7698.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054422 = Hospital System Supply Identifier | 876872 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ12","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054423","type":"LOCAL"},{"code":"876873","type":"LOCAL"}],"standard_charges":[{"gross_charge":10504.89,"discounted_cash":7878.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054423 = Hospital System Supply Identifier | 876873 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ14","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054424","type":"LOCAL"},{"code":"876874","type":"LOCAL"}],"standard_charges":[{"gross_charge":10743.03,"discounted_cash":8057.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054424 = Hospital System Supply Identifier | 876874 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ16","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054425","type":"LOCAL"},{"code":"876875","type":"LOCAL"}],"standard_charges":[{"gross_charge":10923.55,"discounted_cash":8192.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054425 = Hospital System Supply Identifier | 876875 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ18","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054426","type":"LOCAL"},{"code":"876876","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.21,"discounted_cash":8855.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054426 = Hospital System Supply Identifier | 876876 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ4","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054427","type":"LOCAL"},{"code":"876877","type":"LOCAL"}],"standard_charges":[{"gross_charge":9114.54,"discounted_cash":6835.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054427 = Hospital System Supply Identifier | 876877 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ6","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054428","type":"LOCAL"},{"code":"876878","type":"LOCAL"}],"standard_charges":[{"gross_charge":9346.24,"discounted_cash":7009.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054428 = Hospital System Supply Identifier | 876878 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ8","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054429","type":"LOCAL"},{"code":"876879","type":"LOCAL"}],"standard_charges":[{"gross_charge":9545.04,"discounted_cash":7158.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054429 = Hospital System Supply Identifier | 876879 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ18","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054434","type":"LOCAL"},{"code":"876884","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.21,"discounted_cash":8855.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054434 = Hospital System Supply Identifier | 876884 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ16","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054433","type":"LOCAL"},{"code":"876883","type":"LOCAL"}],"standard_charges":[{"gross_charge":10923.55,"discounted_cash":8192.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054433 = Hospital System Supply Identifier | 876883 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ10","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054430","type":"LOCAL"},{"code":"876880","type":"LOCAL"}],"standard_charges":[{"gross_charge":10264.32,"discounted_cash":7698.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054430 = Hospital System Supply Identifier | 876880 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ12","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054431","type":"LOCAL"},{"code":"876881","type":"LOCAL"}],"standard_charges":[{"gross_charge":10504.89,"discounted_cash":7878.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054431 = Hospital System Supply Identifier | 876881 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ14","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054432","type":"LOCAL"},{"code":"876882","type":"LOCAL"}],"standard_charges":[{"gross_charge":10743.03,"discounted_cash":8057.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054432 = Hospital System Supply Identifier | 876882 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 18HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054439","type":"LOCAL"},{"code":"876889","type":"LOCAL"}],"standard_charges":[{"gross_charge":7892.35,"discounted_cash":5919.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054439 = Hospital System Supply Identifier | 876889 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054435","type":"LOCAL"},{"code":"876885","type":"LOCAL"}],"standard_charges":[{"gross_charge":5903.6,"discounted_cash":4427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054435 = Hospital System Supply Identifier | 876885 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 12HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054436","type":"LOCAL"},{"code":"876886","type":"LOCAL"}],"standard_charges":[{"gross_charge":6125.54,"discounted_cash":4594.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054436 = Hospital System Supply Identifier | 876886 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054437","type":"LOCAL"},{"code":"876887","type":"LOCAL"}],"standard_charges":[{"gross_charge":6449.62,"discounted_cash":4837.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054437 = Hospital System Supply Identifier | 876887 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 16HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054438","type":"LOCAL"},{"code":"876888","type":"LOCAL"}],"standard_charges":[{"gross_charge":7559.42,"discounted_cash":5669.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054438 = Hospital System Supply Identifier | 876888 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 8HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054442","type":"LOCAL"},{"code":"876892","type":"LOCAL"}],"standard_charges":[{"gross_charge":5350.95,"discounted_cash":4013.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054442 = Hospital System Supply Identifier | 876892 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 4HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054440","type":"LOCAL"},{"code":"876890","type":"LOCAL"}],"standard_charges":[{"gross_charge":4220.31,"discounted_cash":3165.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054440 = Hospital System Supply Identifier | 876890 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 6HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054441","type":"LOCAL"},{"code":"876891","type":"LOCAL"}],"standard_charges":[{"gross_charge":4794.12,"discounted_cash":3595.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054441 = Hospital System Supply Identifier | 876891 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054443","type":"LOCAL"},{"code":"876893","type":"LOCAL"}],"standard_charges":[{"gross_charge":5903.6,"discounted_cash":4427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054443 = Hospital System Supply Identifier | 876893 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054444","type":"LOCAL"},{"code":"876894","type":"LOCAL"}],"standard_charges":[{"gross_charge":6449.62,"discounted_cash":4837.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054444 = Hospital System Supply Identifier | 876894 = Lawson ID"}]},{"description":"WASHERS","code_information":[{"code":"Sx00-1071-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054445","type":"LOCAL"},{"code":"876895","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054445 = Hospital System Supply Identifier | 876895 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X30MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054446","type":"LOCAL"},{"code":"876896","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054446 = Hospital System Supply Identifier | 876896 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X35MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054447","type":"LOCAL"},{"code":"876897","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054447 = Hospital System Supply Identifier | 876897 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X40MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054448","type":"LOCAL"},{"code":"876898","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054448 = Hospital System Supply Identifier | 876898 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X45MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054449","type":"LOCAL"},{"code":"876899","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054449 = Hospital System Supply Identifier | 876899 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X55MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054451","type":"LOCAL"},{"code":"876901","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054451 = Hospital System Supply Identifier | 876901 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X50MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054450","type":"LOCAL"},{"code":"876900","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054450 = Hospital System Supply Identifier | 876900 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X60MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054452","type":"LOCAL"},{"code":"876902","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054452 = Hospital System Supply Identifier | 876902 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X65MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054453","type":"LOCAL"},{"code":"876903","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054453 = Hospital System Supply Identifier | 876903 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X70MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054454","type":"LOCAL"},{"code":"876904","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054454 = Hospital System Supply Identifier | 876904 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X75MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054455","type":"LOCAL"},{"code":"876905","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054455 = Hospital System Supply Identifier | 876905 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X80MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054456","type":"LOCAL"},{"code":"876906","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054456 = Hospital System Supply Identifier | 876906 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X85MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054457","type":"LOCAL"},{"code":"876907","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054457 = Hospital System Supply Identifier | 876907 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X95MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054459","type":"LOCAL"},{"code":"876909","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054459 = Hospital System Supply Identifier | 876909 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X90MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054458","type":"LOCAL"},{"code":"876908","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054458 = Hospital System Supply Identifier | 876908 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X105MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054461","type":"LOCAL"},{"code":"876911","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054461 = Hospital System Supply Identifier | 876911 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X100MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054460","type":"LOCAL"},{"code":"876910","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054460 = Hospital System Supply Identifier | 876910 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X110MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054462","type":"LOCAL"},{"code":"876912","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054462 = Hospital System Supply Identifier | 876912 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X115MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054463","type":"LOCAL"},{"code":"876913","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054463 = Hospital System Supply Identifier | 876913 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X120MM","code_information":[{"code":"Sx00-1071-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054464","type":"LOCAL"},{"code":"876914","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054464 = Hospital System Supply Identifier | 876914 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054465","type":"LOCAL"},{"code":"876915","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054465 = Hospital System Supply Identifier | 876915 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054466","type":"LOCAL"},{"code":"876916","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054466 = Hospital System Supply Identifier | 876916 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054467","type":"LOCAL"},{"code":"876917","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054467 = Hospital System Supply Identifier | 876917 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054468","type":"LOCAL"},{"code":"876918","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054468 = Hospital System Supply Identifier | 876918 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054470","type":"LOCAL"},{"code":"876920","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054470 = Hospital System Supply Identifier | 876920 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054469","type":"LOCAL"},{"code":"876919","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054469 = Hospital System Supply Identifier | 876919 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054471","type":"LOCAL"},{"code":"876921","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054471 = Hospital System Supply Identifier | 876921 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054472","type":"LOCAL"},{"code":"876922","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054472 = Hospital System Supply Identifier | 876922 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054473","type":"LOCAL"},{"code":"876923","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054473 = Hospital System Supply Identifier | 876923 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054474","type":"LOCAL"},{"code":"876924","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054474 = Hospital System Supply Identifier | 876924 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054475","type":"LOCAL"},{"code":"876925","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054475 = Hospital System Supply Identifier | 876925 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054476","type":"LOCAL"},{"code":"876926","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054476 = Hospital System Supply Identifier | 876926 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054478","type":"LOCAL"},{"code":"876928","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054478 = Hospital System Supply Identifier | 876928 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054477","type":"LOCAL"},{"code":"876927","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054477 = Hospital System Supply Identifier | 876927 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054479","type":"LOCAL"},{"code":"876929","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054479 = Hospital System Supply Identifier | 876929 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X35MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054481","type":"LOCAL"},{"code":"876931","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054481 = Hospital System Supply Identifier | 876931 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X30MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054480","type":"LOCAL"},{"code":"876930","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054480 = Hospital System Supply Identifier | 876930 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X40MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054482","type":"LOCAL"},{"code":"876932","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054482 = Hospital System Supply Identifier | 876932 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X45MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054483","type":"LOCAL"},{"code":"876933","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054483 = Hospital System Supply Identifier | 876933 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054484","type":"LOCAL"},{"code":"876934","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054484 = Hospital System Supply Identifier | 876934 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054485","type":"LOCAL"},{"code":"876935","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054485 = Hospital System Supply Identifier | 876935 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054486","type":"LOCAL"},{"code":"876936","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054486 = Hospital System Supply Identifier | 876936 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054487","type":"LOCAL"},{"code":"876937","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054487 = Hospital System Supply Identifier | 876937 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054489","type":"LOCAL"},{"code":"876939","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054489 = Hospital System Supply Identifier | 876939 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054488","type":"LOCAL"},{"code":"876938","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054488 = Hospital System Supply Identifier | 876938 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054491","type":"LOCAL"},{"code":"876941","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054491 = Hospital System Supply Identifier | 876941 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054490","type":"LOCAL"},{"code":"876940","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054490 = Hospital System Supply Identifier | 876940 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054492","type":"LOCAL"},{"code":"876942","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054492 = Hospital System Supply Identifier | 876942 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054493","type":"LOCAL"},{"code":"876943","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054493 = Hospital System Supply Identifier | 876943 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054494","type":"LOCAL"},{"code":"876944","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054494 = Hospital System Supply Identifier | 876944 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054495","type":"LOCAL"},{"code":"876945","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054495 = Hospital System Supply Identifier | 876945 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054496","type":"LOCAL"},{"code":"876946","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054496 = Hospital System Supply Identifier | 876946 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054497","type":"LOCAL"},{"code":"876947","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054497 = Hospital System Supply Identifier | 876947 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054498","type":"LOCAL"},{"code":"876948","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054498 = Hospital System Supply Identifier | 876948 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X19MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054504","type":"LOCAL"},{"code":"876954","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054504 = Hospital System Supply Identifier | 876954 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054503","type":"LOCAL"},{"code":"876953","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054503 = Hospital System Supply Identifier | 876953 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X17MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054502","type":"LOCAL"},{"code":"876952","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054502 = Hospital System Supply Identifier | 876952 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054501","type":"LOCAL"},{"code":"876951","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054501 = Hospital System Supply Identifier | 876951 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X15MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054500","type":"LOCAL"},{"code":"876950","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054500 = Hospital System Supply Identifier | 876950 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054499","type":"LOCAL"},{"code":"876949","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054499 = Hospital System Supply Identifier | 876949 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054505","type":"LOCAL"},{"code":"876955","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054505 = Hospital System Supply Identifier | 876955 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X21MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054506","type":"LOCAL"},{"code":"876956","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054506 = Hospital System Supply Identifier | 876956 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054507","type":"LOCAL"},{"code":"876957","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054507 = Hospital System Supply Identifier | 876957 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X23MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054508","type":"LOCAL"},{"code":"876958","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054508 = Hospital System Supply Identifier | 876958 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054509","type":"LOCAL"},{"code":"876959","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054509 = Hospital System Supply Identifier | 876959 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054510","type":"LOCAL"},{"code":"876960","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054510 = Hospital System Supply Identifier | 876960 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054511","type":"LOCAL"},{"code":"876961","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054511 = Hospital System Supply Identifier | 876961 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054516","type":"LOCAL"},{"code":"876966","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054516 = Hospital System Supply Identifier | 876966 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054515","type":"LOCAL"},{"code":"876965","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054515 = Hospital System Supply Identifier | 876965 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054513","type":"LOCAL"},{"code":"876963","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054513 = Hospital System Supply Identifier | 876963 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054512","type":"LOCAL"},{"code":"876962","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054512 = Hospital System Supply Identifier | 876962 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054514","type":"LOCAL"},{"code":"876964","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054514 = Hospital System Supply Identifier | 876964 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054517","type":"LOCAL"},{"code":"876967","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054517 = Hospital System Supply Identifier | 876967 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054518","type":"LOCAL"},{"code":"876968","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054518 = Hospital System Supply Identifier | 876968 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1071-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054519","type":"LOCAL"},{"code":"876969","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054519 = Hospital System Supply Identifier | 876969 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X16MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054526","type":"LOCAL"},{"code":"876976","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054526 = Hospital System Supply Identifier | 876976 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X19MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054529","type":"LOCAL"},{"code":"876979","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054529 = Hospital System Supply Identifier | 876979 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X18MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054528","type":"LOCAL"},{"code":"876978","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054528 = Hospital System Supply Identifier | 876978 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X17MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054527","type":"LOCAL"},{"code":"876977","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054527 = Hospital System Supply Identifier | 876977 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X15MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054525","type":"LOCAL"},{"code":"876975","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054525 = Hospital System Supply Identifier | 876975 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X12MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054522","type":"LOCAL"},{"code":"876972","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054522 = Hospital System Supply Identifier | 876972 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X13MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054523","type":"LOCAL"},{"code":"876973","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054523 = Hospital System Supply Identifier | 876973 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X11MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054521","type":"LOCAL"},{"code":"876971","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054521 = Hospital System Supply Identifier | 876971 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X10MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054520","type":"LOCAL"},{"code":"876970","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054520 = Hospital System Supply Identifier | 876970 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X14MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054524","type":"LOCAL"},{"code":"876974","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054524 = Hospital System Supply Identifier | 876974 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X28MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054536","type":"LOCAL"},{"code":"876986","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054536 = Hospital System Supply Identifier | 876986 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X26MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054535","type":"LOCAL"},{"code":"876985","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054535 = Hospital System Supply Identifier | 876985 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X23MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054533","type":"LOCAL"},{"code":"876983","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054533 = Hospital System Supply Identifier | 876983 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X24MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054534","type":"LOCAL"},{"code":"876984","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054534 = Hospital System Supply Identifier | 876984 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X21MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054531","type":"LOCAL"},{"code":"876981","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054531 = Hospital System Supply Identifier | 876981 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X20MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054530","type":"LOCAL"},{"code":"876980","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054530 = Hospital System Supply Identifier | 876980 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X22MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054532","type":"LOCAL"},{"code":"876982","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054532 = Hospital System Supply Identifier | 876982 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X38MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054541","type":"LOCAL"},{"code":"876991","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054541 = Hospital System Supply Identifier | 876991 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X30MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054537","type":"LOCAL"},{"code":"876987","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054537 = Hospital System Supply Identifier | 876987 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X32MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054538","type":"LOCAL"},{"code":"876988","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054538 = Hospital System Supply Identifier | 876988 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X34MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054539","type":"LOCAL"},{"code":"876989","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054539 = Hospital System Supply Identifier | 876989 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X36MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054540","type":"LOCAL"},{"code":"876990","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054540 = Hospital System Supply Identifier | 876990 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X45MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054543","type":"LOCAL"},{"code":"876993","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054543 = Hospital System Supply Identifier | 876993 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X40MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054542","type":"LOCAL"},{"code":"876992","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054542 = Hospital System Supply Identifier | 876992 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X50MM","code_information":[{"code":"Sx00-1071-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054544","type":"LOCAL"},{"code":"876994","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054544 = Hospital System Supply Identifier | 876994 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X10MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054545","type":"LOCAL"},{"code":"876995","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054545 = Hospital System Supply Identifier | 876995 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X12MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054546","type":"LOCAL"},{"code":"876996","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054546 = Hospital System Supply Identifier | 876996 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X14MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054547","type":"LOCAL"},{"code":"876997","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054547 = Hospital System Supply Identifier | 876997 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X16MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054548","type":"LOCAL"},{"code":"876998","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054548 = Hospital System Supply Identifier | 876998 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X18MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054549","type":"LOCAL"},{"code":"876999","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054549 = Hospital System Supply Identifier | 876999 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X28MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054554","type":"LOCAL"},{"code":"877004","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054554 = Hospital System Supply Identifier | 877004 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X24MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054552","type":"LOCAL"},{"code":"877002","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054552 = Hospital System Supply Identifier | 877002 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X26MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054553","type":"LOCAL"},{"code":"877003","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054553 = Hospital System Supply Identifier | 877003 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X20MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054550","type":"LOCAL"},{"code":"877000","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054550 = Hospital System Supply Identifier | 877000 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X22MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054551","type":"LOCAL"},{"code":"877001","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054551 = Hospital System Supply Identifier | 877001 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X30MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054555","type":"LOCAL"},{"code":"877005","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054555 = Hospital System Supply Identifier | 877005 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X32MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054556","type":"LOCAL"},{"code":"877006","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054556 = Hospital System Supply Identifier | 877006 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X34MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054557","type":"LOCAL"},{"code":"877007","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054557 = Hospital System Supply Identifier | 877007 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X35MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054558","type":"LOCAL"},{"code":"877008","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054558 = Hospital System Supply Identifier | 877008 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X36MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054559","type":"LOCAL"},{"code":"877009","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054559 = Hospital System Supply Identifier | 877009 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X38MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054560","type":"LOCAL"},{"code":"877010","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054560 = Hospital System Supply Identifier | 877010 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X46MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054565","type":"LOCAL"},{"code":"877015","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054565 = Hospital System Supply Identifier | 877015 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X48MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054566","type":"LOCAL"},{"code":"877016","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054566 = Hospital System Supply Identifier | 877016 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X45MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054564","type":"LOCAL"},{"code":"877014","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054564 = Hospital System Supply Identifier | 877014 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X44MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054563","type":"LOCAL"},{"code":"877013","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054563 = Hospital System Supply Identifier | 877013 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X42MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054562","type":"LOCAL"},{"code":"877012","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054562 = Hospital System Supply Identifier | 877012 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X40MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054561","type":"LOCAL"},{"code":"877011","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054561 = Hospital System Supply Identifier | 877011 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X50MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054567","type":"LOCAL"},{"code":"877017","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054567 = Hospital System Supply Identifier | 877017 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X55MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054568","type":"LOCAL"},{"code":"877018","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054568 = Hospital System Supply Identifier | 877018 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X60MM","code_information":[{"code":"Sx00-1071-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054569","type":"LOCAL"},{"code":"877019","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054569 = Hospital System Supply Identifier | 877019 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054574","type":"LOCAL"},{"code":"877024","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054574 = Hospital System Supply Identifier | 877024 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054572","type":"LOCAL"},{"code":"877022","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054572 = Hospital System Supply Identifier | 877022 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054573","type":"LOCAL"},{"code":"877023","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054573 = Hospital System Supply Identifier | 877023 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054570","type":"LOCAL"},{"code":"877020","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054570 = Hospital System Supply Identifier | 877020 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054571","type":"LOCAL"},{"code":"877021","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054571 = Hospital System Supply Identifier | 877021 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054575","type":"LOCAL"},{"code":"877025","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054575 = Hospital System Supply Identifier | 877025 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054576","type":"LOCAL"},{"code":"877026","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054576 = Hospital System Supply Identifier | 877026 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054577","type":"LOCAL"},{"code":"877027","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054577 = Hospital System Supply Identifier | 877027 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054578","type":"LOCAL"},{"code":"877028","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054578 = Hospital System Supply Identifier | 877028 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054579","type":"LOCAL"},{"code":"877029","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054579 = Hospital System Supply Identifier | 877029 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054581","type":"LOCAL"},{"code":"877031","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054581 = Hospital System Supply Identifier | 877031 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054580","type":"LOCAL"},{"code":"877030","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054580 = Hospital System Supply Identifier | 877030 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054582","type":"LOCAL"},{"code":"877032","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054582 = Hospital System Supply Identifier | 877032 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054587","type":"LOCAL"},{"code":"877037","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054587 = Hospital System Supply Identifier | 877037 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054586","type":"LOCAL"},{"code":"877036","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054586 = Hospital System Supply Identifier | 877036 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054585","type":"LOCAL"},{"code":"877035","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054585 = Hospital System Supply Identifier | 877035 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054584","type":"LOCAL"},{"code":"877034","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054584 = Hospital System Supply Identifier | 877034 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054583","type":"LOCAL"},{"code":"877033","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054583 = Hospital System Supply Identifier | 877033 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054588","type":"LOCAL"},{"code":"877038","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054588 = Hospital System Supply Identifier | 877038 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054589","type":"LOCAL"},{"code":"877039","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054589 = Hospital System Supply Identifier | 877039 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054590","type":"LOCAL"},{"code":"877040","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054590 = Hospital System Supply Identifier | 877040 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054591","type":"LOCAL"},{"code":"877041","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054591 = Hospital System Supply Identifier | 877041 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054592","type":"LOCAL"},{"code":"877042","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054592 = Hospital System Supply Identifier | 877042 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054597","type":"LOCAL"},{"code":"877047","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054597 = Hospital System Supply Identifier | 877047 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054596","type":"LOCAL"},{"code":"877046","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054596 = Hospital System Supply Identifier | 877046 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054595","type":"LOCAL"},{"code":"877045","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054595 = Hospital System Supply Identifier | 877045 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054594","type":"LOCAL"},{"code":"877044","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054594 = Hospital System Supply Identifier | 877044 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054593","type":"LOCAL"},{"code":"877043","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054593 = Hospital System Supply Identifier | 877043 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054598","type":"LOCAL"},{"code":"877048","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054598 = Hospital System Supply Identifier | 877048 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054599","type":"LOCAL"},{"code":"877049","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054599 = Hospital System Supply Identifier | 877049 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054600","type":"LOCAL"},{"code":"877050","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054600 = Hospital System Supply Identifier | 877050 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054601","type":"LOCAL"},{"code":"877051","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054601 = Hospital System Supply Identifier | 877051 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054602","type":"LOCAL"},{"code":"877052","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054602 = Hospital System Supply Identifier | 877052 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054603","type":"LOCAL"},{"code":"877053","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054603 = Hospital System Supply Identifier | 877053 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054604","type":"LOCAL"},{"code":"877054","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054604 = Hospital System Supply Identifier | 877054 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054605","type":"LOCAL"},{"code":"877055","type":"LOCAL"}],"standard_charges":[{"gross_charge":594.3,"discounted_cash":445.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054605 = Hospital System Supply Identifier | 877055 = Lawson ID"}]},{"description":"CEM BONE DOUGH-TYPE 40/20","code_information":[{"code":"Sx00-1102-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"34976","type":"LOCAL"},{"code":"100111","type":"LOCAL"}],"standard_charges":[{"gross_charge":198.94,"discounted_cash":149.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 34976 = Hospital System Supply Identifier | 100111 = Lawson ID"}]},{"description":"CEM BONE PALACOS-R 40GM","code_information":[{"code":"Sx00-1112-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17042","type":"LOCAL"},{"code":"141046","type":"LOCAL"}],"standard_charges":[{"gross_charge":161.15,"discounted_cash":120.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 17042 = Hospital System Supply Identifier | 141046 = Lawson ID"}]},{"description":"OFF CONTRACT USE 702836 - CEM BONE PALACOS-R/G 40GM","code_information":[{"code":"Sx00-1113-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"20122","type":"LOCAL"},{"code":"238388","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.7,"discounted_cash":417.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 20122 = Hospital System Supply Identifier | 238388 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV 40GM","code_information":[{"code":"Sx00-1118-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176736","type":"LOCAL"},{"code":"308782","type":"LOCAL"}],"standard_charges":[{"gross_charge":161.15,"discounted_cash":120.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 176736 = Hospital System Supply Identifier | 308782 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV/G 40GM","code_information":[{"code":"Sx00-1119-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176737","type":"LOCAL"},{"code":"308783","type":"LOCAL"}],"standard_charges":[{"gross_charge":556.7,"discounted_cash":417.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 176737 = Hospital System Supply Identifier | 308783 = Lawson ID"}]},{"description":"INST DRIVER SCRW MINI MAGNA","code_information":[{"code":"Sx00-1142-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"149709","type":"LOCAL"},{"code":"237164","type":"LOCAL"}],"standard_charges":[{"gross_charge":772.59,"discounted_cash":579.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 149709 = Hospital System Supply Identifier | 237164 = Lawson ID"}]},{"description":"DISC - DRILL CANNUL 3.5","code_information":[{"code":"Sx00-1142-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"166679","type":"LOCAL"},{"code":"148674","type":"LOCAL"}],"standard_charges":[{"gross_charge":498.1,"discounted_cash":373.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 166679 = Hospital System Supply Identifier | 148674 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X65MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408714","type":"LOCAL"},{"code":"339432","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408714 = Hospital System Supply Identifier | 339432 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X32MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408713","type":"LOCAL"},{"code":"339431","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408713 = Hospital System Supply Identifier | 339431 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X28MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408712","type":"LOCAL"},{"code":"339430","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408712 = Hospital System Supply Identifier | 339430 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X48MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408416","type":"LOCAL"},{"code":"323779","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408416 = Hospital System Supply Identifier | 323779 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X55MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148466","type":"LOCAL"},{"code":"235493","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148466 = Hospital System Supply Identifier | 235493 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X44MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148465","type":"LOCAL"},{"code":"235492","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148465 = Hospital System Supply Identifier | 235492 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X40MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148464","type":"LOCAL"},{"code":"235491","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148464 = Hospital System Supply Identifier | 235491 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X36MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148463","type":"LOCAL"},{"code":"235490","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148463 = Hospital System Supply Identifier | 235490 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X60MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408718","type":"LOCAL"},{"code":"339437","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408718 = Hospital System Supply Identifier | 339437 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X48MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408717","type":"LOCAL"},{"code":"339436","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408717 = Hospital System Supply Identifier | 339436 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X36MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408716","type":"LOCAL"},{"code":"339435","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408716 = Hospital System Supply Identifier | 339435 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X30MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408715","type":"LOCAL"},{"code":"339434","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408715 = Hospital System Supply Identifier | 339434 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X55MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148477","type":"LOCAL"},{"code":"235504","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148477 = Hospital System Supply Identifier | 235504 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X50MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148476","type":"LOCAL"},{"code":"235503","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148476 = Hospital System Supply Identifier | 235503 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X44MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148474","type":"LOCAL"},{"code":"235501","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148474 = Hospital System Supply Identifier | 235501 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X42MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148473","type":"LOCAL"},{"code":"235500","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148473 = Hospital System Supply Identifier | 235500 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X40MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148472","type":"LOCAL"},{"code":"235499","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148472 = Hospital System Supply Identifier | 235499 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X38MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148471","type":"LOCAL"},{"code":"235498","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148471 = Hospital System Supply Identifier | 235498 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X34MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148470","type":"LOCAL"},{"code":"235497","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148470 = Hospital System Supply Identifier | 235497 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X32MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148469","type":"LOCAL"},{"code":"235496","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148469 = Hospital System Supply Identifier | 235496 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X46MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148475","type":"LOCAL"},{"code":"235502","type":"LOCAL"}],"standard_charges":[{"gross_charge":468.47,"discounted_cash":351.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148475 = Hospital System Supply Identifier | 235502 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X44MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148495","type":"LOCAL"},{"code":"235526","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148495 = Hospital System Supply Identifier | 235526 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X48MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148496","type":"LOCAL"},{"code":"235527","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148496 = Hospital System Supply Identifier | 235527 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X55MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148497","type":"LOCAL"},{"code":"235528","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 148497 = Hospital System Supply Identifier | 235528 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X12MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408719","type":"LOCAL"},{"code":"339439","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408719 = Hospital System Supply Identifier | 339439 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X16MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408720","type":"LOCAL"},{"code":"339440","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408720 = Hospital System Supply Identifier | 339440 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X65MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408721","type":"LOCAL"},{"code":"339443","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408721 = Hospital System Supply Identifier | 339443 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X55","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35084","type":"LOCAL"},{"code":"116083","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35084 = Hospital System Supply Identifier | 116083 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X65","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35086","type":"LOCAL"},{"code":"116086","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35086 = Hospital System Supply Identifier | 116086 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X60","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35085","type":"LOCAL"},{"code":"116084","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35085 = Hospital System Supply Identifier | 116084 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X48","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35082","type":"LOCAL"},{"code":"116081","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35082 = Hospital System Supply Identifier | 116081 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X50","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35083","type":"LOCAL"},{"code":"116082","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35083 = Hospital System Supply Identifier | 116082 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X40","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35078","type":"LOCAL"},{"code":"116076","type":"LOCAL"}],"standard_charges":[{"gross_charge":362.14,"discounted_cash":271.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35078 = Hospital System Supply Identifier | 116076 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X36","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35076","type":"LOCAL"},{"code":"116074","type":"LOCAL"}],"standard_charges":[{"gross_charge":331.09,"discounted_cash":248.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35076 = Hospital System Supply Identifier | 116074 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X34","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35075","type":"LOCAL"},{"code":"116073","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35075 = Hospital System Supply Identifier | 116073 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X30","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35073","type":"LOCAL"},{"code":"116071","type":"LOCAL"}],"standard_charges":[{"gross_charge":476.12,"discounted_cash":357.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35073 = Hospital System Supply Identifier | 116071 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X44","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35080","type":"LOCAL"},{"code":"116079","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.62,"discounted_cash":282.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35080 = Hospital System Supply Identifier | 116079 = Lawson ID"}]},{"description":"DISC - TAP SURG CANN CHS SCRW 7MM","code_information":[{"code":"Sx00-1146-007","type":"CDM"},{"code":"272","type":"RC"},{"code":"407535","type":"LOCAL"},{"code":"202373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407535 = Hospital System Supply Identifier | 202373 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X30","code_information":[{"code":"Sx00-1146-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407529","type":"LOCAL"},{"code":"201497","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407529 = Hospital System Supply Identifier | 201497 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X55","code_information":[{"code":"Sx00-1146-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407550","type":"LOCAL"},{"code":"205031","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407550 = Hospital System Supply Identifier | 205031 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X75","code_information":[{"code":"Sx00-1146-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407512","type":"LOCAL"},{"code":"201197","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407512 = Hospital System Supply Identifier | 201197 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408763","type":"LOCAL"},{"code":"339795","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408763 = Hospital System Supply Identifier | 339795 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53570","type":"LOCAL"},{"code":"116091","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53570 = Hospital System Supply Identifier | 116091 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407517","type":"LOCAL"},{"code":"201359","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407517 = Hospital System Supply Identifier | 201359 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53571","type":"LOCAL"},{"code":"116092","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53571 = Hospital System Supply Identifier | 116092 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407513","type":"LOCAL"},{"code":"201198","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407513 = Hospital System Supply Identifier | 201198 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408764","type":"LOCAL"},{"code":"339796","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408764 = Hospital System Supply Identifier | 339796 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53572","type":"LOCAL"},{"code":"116093","type":"LOCAL"}],"standard_charges":[{"gross_charge":442.43,"discounted_cash":331.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53572 = Hospital System Supply Identifier | 116093 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407515","type":"LOCAL"},{"code":"201293","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407515 = Hospital System Supply Identifier | 201293 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408765","type":"LOCAL"},{"code":"339797","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408765 = Hospital System Supply Identifier | 339797 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X95","code_information":[{"code":"Sx00-1146-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53573","type":"LOCAL"},{"code":"116094","type":"LOCAL"}],"standard_charges":[{"gross_charge":404.34,"discounted_cash":303.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53573 = Hospital System Supply Identifier | 116094 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X95","code_information":[{"code":"Sx00-1146-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407516","type":"LOCAL"},{"code":"201358","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407516 = Hospital System Supply Identifier | 201358 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X100","code_information":[{"code":"Sx00-1146-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408766","type":"LOCAL"},{"code":"339799","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408766 = Hospital System Supply Identifier | 339799 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X100","code_information":[{"code":"Sx00-1146-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53574","type":"LOCAL"},{"code":"116095","type":"LOCAL"}],"standard_charges":[{"gross_charge":473.92,"discounted_cash":355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 53574 = Hospital System Supply Identifier | 116095 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X105","code_information":[{"code":"Sx00-1146-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408767","type":"LOCAL"},{"code":"339800","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408767 = Hospital System Supply Identifier | 339800 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X110","code_information":[{"code":"Sx00-1146-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408768","type":"LOCAL"},{"code":"339801","type":"LOCAL"}],"standard_charges":[{"gross_charge":581.14,"discounted_cash":435.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408768 = Hospital System Supply Identifier | 339801 = Lawson ID"}]},{"description":"DUP USE 815633 - PIN GUIDE 1.6MM","code_information":[{"code":"Sx00-1147-006","type":"CDM"},{"code":"272","type":"RC"},{"code":"408926","type":"LOCAL"},{"code":"343898","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.84,"discounted_cash":666.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408926 = Hospital System Supply Identifier | 343898 = Lawson ID"}]},{"description":"DUP USE 815634 - PIN GUIDE 3.2MM","code_information":[{"code":"Sx00-1147-009","type":"CDM"},{"code":"272","type":"RC"},{"code":"408945","type":"LOCAL"},{"code":"343919","type":"LOCAL"}],"standard_charges":[{"gross_charge":888.84,"discounted_cash":666.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408945 = Hospital System Supply Identifier | 343919 = Lawson ID"}]},{"description":"DRILL CANN Q/C 2.3MM","code_information":[{"code":"Sx00-1147-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"195901","type":"LOCAL"},{"code":"395445","type":"LOCAL"}],"standard_charges":[{"gross_charge":713.61,"discounted_cash":535.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 195901 = Hospital System Supply Identifier | 395445 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 2.7MM","code_information":[{"code":"Sx00-1147-026","type":"CDM"},{"code":"272","type":"RC"},{"code":"193566","type":"LOCAL"},{"code":"314877","type":"LOCAL"}],"standard_charges":[{"gross_charge":730.33,"discounted_cash":547.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 193566 = Hospital System Supply Identifier | 314877 = Lawson ID"}]},{"description":"DRILL CANN Q/C 3.2MM","code_information":[{"code":"Sx00-1147-027","type":"CDM"},{"code":"272","type":"RC"},{"code":"195829","type":"LOCAL"},{"code":"393263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 195829 = Hospital System Supply Identifier | 393263 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-028","type":"CDM"},{"code":"272","type":"RC"},{"code":"408769","type":"LOCAL"},{"code":"339806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408769 = Hospital System Supply Identifier | 339806 = Lawson ID"}]},{"description":"DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-029","type":"CDM"},{"code":"272","type":"RC"},{"code":"409110","type":"LOCAL"},{"code":"387535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 409110 = Hospital System Supply Identifier | 387535 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 5.0MM","code_information":[{"code":"Sx00-1147-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"408395","type":"LOCAL"},{"code":"314162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408395 = Hospital System Supply Identifier | 314162 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 4.0MM","code_information":[{"code":"Sx00-1147-038","type":"CDM"},{"code":"272","type":"RC"},{"code":"408923","type":"LOCAL"},{"code":"343895","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408923 = Hospital System Supply Identifier | 343895 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 6.5MM","code_information":[{"code":"Sx00-1147-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"411228","type":"LOCAL"},{"code":"461757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.21,"discounted_cash":762.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411228 = Hospital System Supply Identifier | 461757 = Lawson ID"}]},{"description":"PIN GDE CLUS","code_information":[{"code":"Sx00-1147-061","type":"CDM"},{"code":"272","type":"RC"},{"code":"408949","type":"LOCAL"},{"code":"343924","type":"LOCAL"}],"standard_charges":[{"gross_charge":2990.94,"discounted_cash":2243.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408949 = Hospital System Supply Identifier | 343924 = Lawson ID"}]},{"description":"FCP SCREW HLDING","code_information":[{"code":"Sx00-1147-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"408924","type":"LOCAL"},{"code":"343896","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.77,"discounted_cash":591.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408924 = Hospital System Supply Identifier | 343896 = Lawson ID"}]},{"description":"WASHER CANN SCR 5.5-7.5MM 1.2","code_information":[{"code":"Sx00-1147-099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"721296","type":"LOCAL"},{"code":"732743","type":"LOCAL"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 721296 = Hospital System Supply Identifier | 732743 = Lawson ID"}]},{"description":"SCREW CANN MINI HERB 2.5X16MM","code_information":[{"code":"Sx00-1150-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"151048","type":"LOCAL"},{"code":"250825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1044.81,"discounted_cash":783.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 151048 = Hospital System Supply Identifier | 250825 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 12MM","code_information":[{"code":"Sx00-1152-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15450","type":"LOCAL"},{"code":"114304","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15450 = Hospital System Supply Identifier | 114304 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 14MM","code_information":[{"code":"Sx00-1152-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15451","type":"LOCAL"},{"code":"114305","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15451 = Hospital System Supply Identifier | 114305 = Lawson ID"}]},{"description":"DRILL TIP HERBERT DISP","code_information":[{"code":"Sx00-1152-015","type":"CDM"},{"code":"272","type":"RC"},{"code":"17319","type":"LOCAL"},{"code":"145717","type":"LOCAL"}],"standard_charges":[{"gross_charge":470.41,"discounted_cash":352.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 17319 = Hospital System Supply Identifier | 145717 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 16MM","code_information":[{"code":"Sx00-1152-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15452","type":"LOCAL"},{"code":"114306","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15452 = Hospital System Supply Identifier | 114306 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 18MM","code_information":[{"code":"Sx00-1152-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15849","type":"LOCAL"},{"code":"124103","type":"LOCAL"}],"standard_charges":[{"gross_charge":1196.58,"discounted_cash":897.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15849 = Hospital System Supply Identifier | 124103 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 20MM","code_information":[{"code":"Sx00-1152-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15453","type":"LOCAL"},{"code":"114307","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15453 = Hospital System Supply Identifier | 114307 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 22MM","code_information":[{"code":"Sx00-1152-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17599","type":"LOCAL"},{"code":"154038","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 17599 = Hospital System Supply Identifier | 154038 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 24MM","code_information":[{"code":"Sx00-1152-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15454","type":"LOCAL"},{"code":"114309","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15454 = Hospital System Supply Identifier | 114309 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 26MM","code_information":[{"code":"Sx00-1152-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15455","type":"LOCAL"},{"code":"114310","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15455 = Hospital System Supply Identifier | 114310 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 28MM","code_information":[{"code":"Sx00-1152-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15456","type":"LOCAL"},{"code":"114311","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15456 = Hospital System Supply Identifier | 114311 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 30MM","code_information":[{"code":"Sx00-1152-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15457","type":"LOCAL"},{"code":"114312","type":"LOCAL"}],"standard_charges":[{"gross_charge":987.22,"discounted_cash":740.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 15457 = Hospital System Supply Identifier | 114312 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 24H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408782","type":"LOCAL"},{"code":"339884","type":"LOCAL"}],"standard_charges":[{"gross_charge":1273.06,"discounted_cash":954.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408782 = Hospital System Supply Identifier | 339884 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 22H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408781","type":"LOCAL"},{"code":"339883","type":"LOCAL"}],"standard_charges":[{"gross_charge":1135.64,"discounted_cash":851.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408781 = Hospital System Supply Identifier | 339883 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 20H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408780","type":"LOCAL"},{"code":"339882","type":"LOCAL"}],"standard_charges":[{"gross_charge":979.97,"discounted_cash":734.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408780 = Hospital System Supply Identifier | 339882 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 18H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408779","type":"LOCAL"},{"code":"339881","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.62,"discounted_cash":685.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408779 = Hospital System Supply Identifier | 339881 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 16H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408778","type":"LOCAL"},{"code":"339880","type":"LOCAL"}],"standard_charges":[{"gross_charge":740.41,"discounted_cash":555.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408778 = Hospital System Supply Identifier | 339880 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 14H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408777","type":"LOCAL"},{"code":"339879","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408777 = Hospital System Supply Identifier | 339879 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 12H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408776","type":"LOCAL"},{"code":"339878","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408776 = Hospital System Supply Identifier | 339878 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 10H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408775","type":"LOCAL"},{"code":"339877","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408775 = Hospital System Supply Identifier | 339877 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 8H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408774","type":"LOCAL"},{"code":"339876","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408774 = Hospital System Supply Identifier | 339876 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 6H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408773","type":"LOCAL"},{"code":"339875","type":"LOCAL"}],"standard_charges":[{"gross_charge":721.98,"discounted_cash":541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408773 = Hospital System Supply Identifier | 339875 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-03","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407518","type":"LOCAL"},{"code":"201370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407518 = Hospital System Supply Identifier | 201370 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-02","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407531","type":"LOCAL"},{"code":"201833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407531 = Hospital System Supply Identifier | 201833 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-03","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407509","type":"LOCAL"},{"code":"200695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407509 = Hospital System Supply Identifier | 200695 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-02","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407542","type":"LOCAL"},{"code":"203357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407542 = Hospital System Supply Identifier | 203357 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-02","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407543","type":"LOCAL"},{"code":"203361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407543 = Hospital System Supply Identifier | 203361 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-03","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407510","type":"LOCAL"},{"code":"201155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407510 = Hospital System Supply Identifier | 201155 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-03","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407511","type":"LOCAL"},{"code":"201175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407511 = Hospital System Supply Identifier | 201175 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-02","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407545","type":"LOCAL"},{"code":"204507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407545 = Hospital System Supply Identifier | 204507 = Lawson ID"}]},{"description":"PLATE SUPCNDYL TB 150 2H","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407530","type":"LOCAL"},{"code":"201531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407530 = Hospital System Supply Identifier | 201531 = Lawson ID"}]},{"description":"PLATE TUBE 150 1181-150-03","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407546","type":"LOCAL"},{"code":"204516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1068.27,"discounted_cash":801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407546 = Hospital System Supply Identifier | 204516 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 18GA","code_information":[{"code":"Sx00-1191-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"20912","type":"LOCAL"},{"code":"103817","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":23.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 20912 = Hospital System Supply Identifier | 103817 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 16GA","code_information":[{"code":"Sx00-1191-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"16374","type":"LOCAL"},{"code":"131618","type":"LOCAL"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":23.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 16374 = Hospital System Supply Identifier | 131618 = Lawson ID"}]},{"description":"PLATE DHS VRSAFX2 95D 16H","code_information":[{"code":"Sx00-1193-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410141","type":"LOCAL"},{"code":"410379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1585.68,"discounted_cash":1189.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 410141 = Hospital System Supply Identifier | 410379 = Lawson ID"}]},{"description":"DISC - PUNCH ORTH TRAB","code_information":[{"code":"Sx00-1197-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"744077","type":"LOCAL"},{"code":"421234","type":"LOCAL"}],"standard_charges":[{"gross_charge":665.05,"discounted_cash":498.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 744077 = Hospital System Supply Identifier | 421234 = Lawson ID"}]},{"description":"ROD ORTH TRABCLR OSTNECROSIS","code_information":[{"code":"Sx00-1197-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408707","type":"LOCAL"},{"code":"339245","type":"LOCAL"}],"standard_charges":[{"gross_charge":10705.04,"discounted_cash":8028.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408707 = Hospital System Supply Identifier | 339245 = Lawson ID"}]},{"description":"IMP HIP OSTEONECROSIS 10X90MM","code_information":[{"code":"Sx00-1197-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"171788","type":"LOCAL"},{"code":"439191","type":"LOCAL"}],"standard_charges":[{"gross_charge":10705.04,"discounted_cash":8028.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 171788 = Hospital System Supply Identifier | 439191 = Lawson ID"}]},{"description":"IMP OSTEONECROSIS 10 X 95MM","code_information":[{"code":"Sx00-1197-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411206","type":"LOCAL"},{"code":"454951","type":"LOCAL"}],"standard_charges":[{"gross_charge":10705.04,"discounted_cash":8028.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411206 = Hospital System Supply Identifier | 454951 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 25X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054606","type":"LOCAL"},{"code":"877056","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054606 = Hospital System Supply Identifier | 877056 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054607","type":"LOCAL"},{"code":"877057","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054607 = Hospital System Supply Identifier | 877057 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054608","type":"LOCAL"},{"code":"877058","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054608 = Hospital System Supply Identifier | 877058 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 25X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054609","type":"LOCAL"},{"code":"877059","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054609 = Hospital System Supply Identifier | 877059 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 30X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054610","type":"LOCAL"},{"code":"877060","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054610 = Hospital System Supply Identifier | 877060 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 35X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054611","type":"LOCAL"},{"code":"877061","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054611 = Hospital System Supply Identifier | 877061 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054613","type":"LOCAL"},{"code":"877063","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054613 = Hospital System Supply Identifier | 877063 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054612","type":"LOCAL"},{"code":"877062","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054612 = Hospital System Supply Identifier | 877062 = Lawson ID"}]},{"description":"BLADE PLATE 5MM X25MM 2H 90-DE","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"813192","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 813192 = Hospital System Supply Identifier"}]},{"description":"PLATE BLD CANN INF 130 25X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054614","type":"LOCAL"},{"code":"877064","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054614 = Hospital System Supply Identifier | 877064 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 30X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054615","type":"LOCAL"},{"code":"877065","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054615 = Hospital System Supply Identifier | 877065 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 35X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054616","type":"LOCAL"},{"code":"877066","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054616 = Hospital System Supply Identifier | 877066 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 40X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054617","type":"LOCAL"},{"code":"877067","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054617 = Hospital System Supply Identifier | 877067 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 45X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054618","type":"LOCAL"},{"code":"877068","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054618 = Hospital System Supply Identifier | 877068 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 50X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054619","type":"LOCAL"},{"code":"877069","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054619 = Hospital System Supply Identifier | 877069 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 55X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054620","type":"LOCAL"},{"code":"877070","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054620 = Hospital System Supply Identifier | 877070 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 60X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054621","type":"LOCAL"},{"code":"877071","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054621 = Hospital System Supply Identifier | 877071 = Lawson ID"}]},{"description":"PLATE BONE CANNULATED CHILD OSTEOTOMY 90 DEGREE 0012003005 6X50MM","code_information":[{"code":"Sx00-1200-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356811","type":"LOCAL"},{"code":"1082556","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356811 = Hospital System Supply Identifier | 1082556 = Lawson ID"}]},{"description":"PLATE 90DEG 40X6MM","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"918407","type":"LOCAL"},{"code":"711670","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 918407 = Hospital System Supply Identifier | 711670 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 25X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054622","type":"LOCAL"},{"code":"877072","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054622 = Hospital System Supply Identifier | 877072 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 30X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054623","type":"LOCAL"},{"code":"877073","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054623 = Hospital System Supply Identifier | 877073 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 35X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054624","type":"LOCAL"},{"code":"877074","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054624 = Hospital System Supply Identifier | 877074 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 45X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054625","type":"LOCAL"},{"code":"877075","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054625 = Hospital System Supply Identifier | 877075 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 50X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054626","type":"LOCAL"},{"code":"877076","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054626 = Hospital System Supply Identifier | 877076 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 25X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054627","type":"LOCAL"},{"code":"877077","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054627 = Hospital System Supply Identifier | 877077 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 30X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054628","type":"LOCAL"},{"code":"877078","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054628 = Hospital System Supply Identifier | 877078 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 35X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054629","type":"LOCAL"},{"code":"877079","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054629 = Hospital System Supply Identifier | 877079 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 40X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054630","type":"LOCAL"},{"code":"877080","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054630 = Hospital System Supply Identifier | 877080 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 45X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054631","type":"LOCAL"},{"code":"877081","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054631 = Hospital System Supply Identifier | 877081 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 50X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054632","type":"LOCAL"},{"code":"877082","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054632 = Hospital System Supply Identifier | 877082 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 50X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054637","type":"LOCAL"},{"code":"877087","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054637 = Hospital System Supply Identifier | 877087 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 40X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054635","type":"LOCAL"},{"code":"877085","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054635 = Hospital System Supply Identifier | 877085 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 45X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054636","type":"LOCAL"},{"code":"877086","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054636 = Hospital System Supply Identifier | 877086 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 30X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054633","type":"LOCAL"},{"code":"877083","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054633 = Hospital System Supply Identifier | 877083 = Lawson ID"}]},{"description":"PLATE BONE 25MM 100-DEG 3-HOLE","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"801298","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 801298 = Hospital System Supply Identifier"}]},{"description":"PLATE BLD CANN CHD 100 35X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054634","type":"LOCAL"},{"code":"877084","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054634 = Hospital System Supply Identifier | 877084 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 40X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054638","type":"LOCAL"},{"code":"877088","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054638 = Hospital System Supply Identifier | 877088 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 45X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054639","type":"LOCAL"},{"code":"877089","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054639 = Hospital System Supply Identifier | 877089 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 50X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054640","type":"LOCAL"},{"code":"877090","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054640 = Hospital System Supply Identifier | 877090 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 55X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054641","type":"LOCAL"},{"code":"877091","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054641 = Hospital System Supply Identifier | 877091 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 60X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054642","type":"LOCAL"},{"code":"877092","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054642 = Hospital System Supply Identifier | 877092 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 65X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054643","type":"LOCAL"},{"code":"877093","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054643 = Hospital System Supply Identifier | 877093 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 70X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054644","type":"LOCAL"},{"code":"877094","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054644 = Hospital System Supply Identifier | 877094 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 65X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054650","type":"LOCAL"},{"code":"877100","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054650 = Hospital System Supply Identifier | 877100 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 60X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054649","type":"LOCAL"},{"code":"877099","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054649 = Hospital System Supply Identifier | 877099 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 55X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054648","type":"LOCAL"},{"code":"877098","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054648 = Hospital System Supply Identifier | 877098 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 50X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054647","type":"LOCAL"},{"code":"877097","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054647 = Hospital System Supply Identifier | 877097 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 45X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054646","type":"LOCAL"},{"code":"877096","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054646 = Hospital System Supply Identifier | 877096 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 40X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054645","type":"LOCAL"},{"code":"877095","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054645 = Hospital System Supply Identifier | 877095 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 70X14X4H","code_information":[{"code":"Sx00-1200-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054651","type":"LOCAL"},{"code":"877101","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054651 = Hospital System Supply Identifier | 877101 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 25X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054652","type":"LOCAL"},{"code":"877102","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054652 = Hospital System Supply Identifier | 877102 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 30X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054653","type":"LOCAL"},{"code":"877103","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054653 = Hospital System Supply Identifier | 877103 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 35X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054654","type":"LOCAL"},{"code":"877104","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054654 = Hospital System Supply Identifier | 877104 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 60X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054659","type":"LOCAL"},{"code":"877109","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054659 = Hospital System Supply Identifier | 877109 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 55X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054658","type":"LOCAL"},{"code":"877108","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054658 = Hospital System Supply Identifier | 877108 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 50X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054657","type":"LOCAL"},{"code":"877107","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054657 = Hospital System Supply Identifier | 877107 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 45X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054656","type":"LOCAL"},{"code":"877106","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054656 = Hospital System Supply Identifier | 877106 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 40X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054655","type":"LOCAL"},{"code":"877105","type":"LOCAL"}],"standard_charges":[{"gross_charge":4416.46,"discounted_cash":3312.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054655 = Hospital System Supply Identifier | 877105 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006003 6X55MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356879","type":"LOCAL"},{"code":"1082448","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356879 = Hospital System Supply Identifier | 1082448 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006004 6X60MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356428","type":"LOCAL"},{"code":"1082464","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356428 = Hospital System Supply Identifier | 1082464 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006002 6X50MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356947","type":"LOCAL"},{"code":"1082483","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356947 = Hospital System Supply Identifier | 1082483 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006006 6X70MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357050","type":"LOCAL"},{"code":"1082534","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357050 = Hospital System Supply Identifier | 1082534 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006005 6X65MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356584","type":"LOCAL"},{"code":"1082547","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356584 = Hospital System Supply Identifier | 1082547 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006001 6X45MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356812","type":"LOCAL"},{"code":"1082571","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356812 = Hospital System Supply Identifier | 1082571 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006000 6X40MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356813","type":"LOCAL"},{"code":"1082574","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356813 = Hospital System Supply Identifier | 1082574 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 80X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054667","type":"LOCAL"},{"code":"877117","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054667 = Hospital System Supply Identifier | 877117 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 75X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054666","type":"LOCAL"},{"code":"877116","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054666 = Hospital System Supply Identifier | 877116 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 70X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054665","type":"LOCAL"},{"code":"877115","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054665 = Hospital System Supply Identifier | 877115 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 65X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054664","type":"LOCAL"},{"code":"877114","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054664 = Hospital System Supply Identifier | 877114 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 45X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054660","type":"LOCAL"},{"code":"877110","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054660 = Hospital System Supply Identifier | 877110 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 55X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054662","type":"LOCAL"},{"code":"877112","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054662 = Hospital System Supply Identifier | 877112 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 50X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054661","type":"LOCAL"},{"code":"877111","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054661 = Hospital System Supply Identifier | 877111 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 60X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054663","type":"LOCAL"},{"code":"877113","type":"LOCAL"}],"standard_charges":[{"gross_charge":4530.92,"discounted_cash":3398.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054663 = Hospital System Supply Identifier | 877113 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 65X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054673","type":"LOCAL"},{"code":"877123","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054673 = Hospital System Supply Identifier | 877123 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 60X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054672","type":"LOCAL"},{"code":"877122","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054672 = Hospital System Supply Identifier | 877122 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 55X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054671","type":"LOCAL"},{"code":"877121","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054671 = Hospital System Supply Identifier | 877121 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 45X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054669","type":"LOCAL"},{"code":"877119","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054669 = Hospital System Supply Identifier | 877119 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 40X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054668","type":"LOCAL"},{"code":"877118","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054668 = Hospital System Supply Identifier | 877118 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 50X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054670","type":"LOCAL"},{"code":"877120","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054670 = Hospital System Supply Identifier | 877120 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 70X10 4H","code_information":[{"code":"Sx00-1200-805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054674","type":"LOCAL"},{"code":"877124","type":"LOCAL"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054674 = Hospital System Supply Identifier | 877124 = Lawson ID"}]},{"description":"SPLINT THOMAS LEG LG 45X9IN","code_information":[{"code":"Sx00-1232-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"393041","type":"LOCAL"},{"code":"449215","type":"LOCAL"}],"standard_charges":[{"gross_charge":465.4,"discounted_cash":349.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 393041 = Hospital System Supply Identifier | 449215 = Lawson ID"}]},{"description":"SPLINT THOMAS RADLUC LG","code_information":[{"code":"Sx00-1232-008","type":"CDM"},{"code":"272","type":"RC"},{"code":"393042","type":"LOCAL"},{"code":"449216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1217.11,"discounted_cash":912.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 393042 = Hospital System Supply Identifier | 449216 = Lawson ID"}]},{"description":"SPLINT PEARSON ATTACH LG 29IN","code_information":[{"code":"Sx00-1232-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"393039","type":"LOCAL"},{"code":"449213","type":"LOCAL"}],"standard_charges":[{"gross_charge":220.33,"discounted_cash":165.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 393039 = Hospital System Supply Identifier | 449213 = Lawson ID"}]},{"description":"BIT DRILIL SHANK 6.4X203MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"411112","type":"LOCAL"},{"code":"437851","type":"LOCAL"}],"standard_charges":[{"gross_charge":484.85,"discounted_cash":363.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411112 = Hospital System Supply Identifier | 437851 = Lawson ID"}]},{"description":"BIT DRILL FIXATION LONG 6.4MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"743293","type":"LOCAL"},{"code":"303894","type":"LOCAL"}],"standard_charges":[{"gross_charge":147.23,"discounted_cash":110.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 743293 = Hospital System Supply Identifier | 303894 = Lawson ID"}]},{"description":"WIRE SPN LUQUE 16GA","code_information":[{"code":"Sx00-1292-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176560","type":"LOCAL"},{"code":"217910","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 176560 = Hospital System Supply Identifier | 217910 = Lawson ID"}]},{"description":"DISC - WIRE SPN LUQUE 18GA","code_information":[{"code":"Sx00-1292-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176561","type":"LOCAL"},{"code":"217911","type":"LOCAL"}],"standard_charges":[{"gross_charge":132.3,"discounted_cash":99.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 176561 = Hospital System Supply Identifier | 217911 = Lawson ID"}]},{"description":"SCREW WASHER CANN 2.5/3.0","code_information":[{"code":"Sx00-1400-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054675","type":"LOCAL"},{"code":"877125","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.45,"discounted_cash":54.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054675 = Hospital System Supply Identifier | 877125 = Lawson ID"}]},{"description":"SCREW WASHER CANN 3.5/4.0","code_information":[{"code":"Sx00-1400-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054676","type":"LOCAL"},{"code":"877126","type":"LOCAL"}],"standard_charges":[{"gross_charge":72.45,"discounted_cash":54.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054676 = Hospital System Supply Identifier | 877126 = Lawson ID"}]},{"description":"SCREW WASHER CANN 4.5","code_information":[{"code":"Sx00-1400-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054677","type":"LOCAL"},{"code":"877127","type":"LOCAL"}],"standard_charges":[{"gross_charge":146.5,"discounted_cash":109.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054677 = Hospital System Supply Identifier | 877127 = Lawson ID"}]},{"description":"SCREW WASHER CANN 5.5","code_information":[{"code":"Sx00-1400-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054678","type":"LOCAL"},{"code":"877128","type":"LOCAL"}],"standard_charges":[{"gross_charge":149.43,"discounted_cash":112.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054678 = Hospital System Supply Identifier | 877128 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X8MM","code_information":[{"code":"Sx00-1400-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054679","type":"LOCAL"},{"code":"877129","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054679 = Hospital System Supply Identifier | 877129 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X18MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054684","type":"LOCAL"},{"code":"877134","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054684 = Hospital System Supply Identifier | 877134 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X14MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054682","type":"LOCAL"},{"code":"877132","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054682 = Hospital System Supply Identifier | 877132 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X16MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054683","type":"LOCAL"},{"code":"877133","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054683 = Hospital System Supply Identifier | 877133 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X10MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054680","type":"LOCAL"},{"code":"877130","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054680 = Hospital System Supply Identifier | 877130 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X12MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054681","type":"LOCAL"},{"code":"877131","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054681 = Hospital System Supply Identifier | 877131 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X20MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054685","type":"LOCAL"},{"code":"877135","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054685 = Hospital System Supply Identifier | 877135 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X22MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054686","type":"LOCAL"},{"code":"877136","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054686 = Hospital System Supply Identifier | 877136 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X24MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054687","type":"LOCAL"},{"code":"877137","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054687 = Hospital System Supply Identifier | 877137 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X26MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054688","type":"LOCAL"},{"code":"877138","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054688 = Hospital System Supply Identifier | 877138 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X28MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054689","type":"LOCAL"},{"code":"877139","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054689 = Hospital System Supply Identifier | 877139 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X30MM","code_information":[{"code":"Sx00-1400-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054690","type":"LOCAL"},{"code":"877140","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054690 = Hospital System Supply Identifier | 877140 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X14MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054693","type":"LOCAL"},{"code":"877143","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054693 = Hospital System Supply Identifier | 877143 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054695","type":"LOCAL"},{"code":"877145","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054695 = Hospital System Supply Identifier | 877145 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054694","type":"LOCAL"},{"code":"877144","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054694 = Hospital System Supply Identifier | 877144 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X12MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054692","type":"LOCAL"},{"code":"877142","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054692 = Hospital System Supply Identifier | 877142 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X10MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054691","type":"LOCAL"},{"code":"877141","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054691 = Hospital System Supply Identifier | 877141 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054696","type":"LOCAL"},{"code":"877146","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054696 = Hospital System Supply Identifier | 877146 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054697","type":"LOCAL"},{"code":"877147","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054697 = Hospital System Supply Identifier | 877147 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054698","type":"LOCAL"},{"code":"877148","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054698 = Hospital System Supply Identifier | 877148 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054699","type":"LOCAL"},{"code":"877149","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054699 = Hospital System Supply Identifier | 877149 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054700","type":"LOCAL"},{"code":"877150","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054700 = Hospital System Supply Identifier | 877150 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054701","type":"LOCAL"},{"code":"877151","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054701 = Hospital System Supply Identifier | 877151 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054702","type":"LOCAL"},{"code":"877152","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054702 = Hospital System Supply Identifier | 877152 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054703","type":"LOCAL"},{"code":"877153","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054703 = Hospital System Supply Identifier | 877153 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054708","type":"LOCAL"},{"code":"877158","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054708 = Hospital System Supply Identifier | 877158 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054707","type":"LOCAL"},{"code":"877157","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054707 = Hospital System Supply Identifier | 877157 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054706","type":"LOCAL"},{"code":"877156","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054706 = Hospital System Supply Identifier | 877156 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054705","type":"LOCAL"},{"code":"877155","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054705 = Hospital System Supply Identifier | 877155 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054704","type":"LOCAL"},{"code":"877154","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054704 = Hospital System Supply Identifier | 877154 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054709","type":"LOCAL"},{"code":"877159","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054709 = Hospital System Supply Identifier | 877159 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X8MM","code_information":[{"code":"Sx00-1400-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054710","type":"LOCAL"},{"code":"877160","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054710 = Hospital System Supply Identifier | 877160 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X10MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054711","type":"LOCAL"},{"code":"877161","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054711 = Hospital System Supply Identifier | 877161 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X12MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054712","type":"LOCAL"},{"code":"877162","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054712 = Hospital System Supply Identifier | 877162 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054713","type":"LOCAL"},{"code":"877163","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054713 = Hospital System Supply Identifier | 877163 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054714","type":"LOCAL"},{"code":"877164","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054714 = Hospital System Supply Identifier | 877164 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054715","type":"LOCAL"},{"code":"877165","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054715 = Hospital System Supply Identifier | 877165 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054720","type":"LOCAL"},{"code":"877170","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054720 = Hospital System Supply Identifier | 877170 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054719","type":"LOCAL"},{"code":"877169","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054719 = Hospital System Supply Identifier | 877169 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054716","type":"LOCAL"},{"code":"877166","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054716 = Hospital System Supply Identifier | 877166 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054717","type":"LOCAL"},{"code":"877167","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054717 = Hospital System Supply Identifier | 877167 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054718","type":"LOCAL"},{"code":"877168","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054718 = Hospital System Supply Identifier | 877168 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054725","type":"LOCAL"},{"code":"877175","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054725 = Hospital System Supply Identifier | 877175 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054721","type":"LOCAL"},{"code":"877171","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054721 = Hospital System Supply Identifier | 877171 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054722","type":"LOCAL"},{"code":"877172","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054722 = Hospital System Supply Identifier | 877172 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054723","type":"LOCAL"},{"code":"877173","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054723 = Hospital System Supply Identifier | 877173 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054724","type":"LOCAL"},{"code":"877174","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054724 = Hospital System Supply Identifier | 877174 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054727","type":"LOCAL"},{"code":"877177","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054727 = Hospital System Supply Identifier | 877177 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054726","type":"LOCAL"},{"code":"877176","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054726 = Hospital System Supply Identifier | 877176 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1400-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054728","type":"LOCAL"},{"code":"877178","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054728 = Hospital System Supply Identifier | 877178 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054729","type":"LOCAL"},{"code":"877179","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054729 = Hospital System Supply Identifier | 877179 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054730","type":"LOCAL"},{"code":"877180","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054730 = Hospital System Supply Identifier | 877180 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054731","type":"LOCAL"},{"code":"877181","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054731 = Hospital System Supply Identifier | 877181 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054732","type":"LOCAL"},{"code":"877182","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054732 = Hospital System Supply Identifier | 877182 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054733","type":"LOCAL"},{"code":"877183","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054733 = Hospital System Supply Identifier | 877183 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054734","type":"LOCAL"},{"code":"877184","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054734 = Hospital System Supply Identifier | 877184 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054735","type":"LOCAL"},{"code":"877185","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054735 = Hospital System Supply Identifier | 877185 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054740","type":"LOCAL"},{"code":"877190","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054740 = Hospital System Supply Identifier | 877190 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054739","type":"LOCAL"},{"code":"877189","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054739 = Hospital System Supply Identifier | 877189 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054736","type":"LOCAL"},{"code":"877186","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054736 = Hospital System Supply Identifier | 877186 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054737","type":"LOCAL"},{"code":"877187","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054737 = Hospital System Supply Identifier | 877187 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054738","type":"LOCAL"},{"code":"877188","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054738 = Hospital System Supply Identifier | 877188 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054741","type":"LOCAL"},{"code":"877191","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054741 = Hospital System Supply Identifier | 877191 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054742","type":"LOCAL"},{"code":"877192","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054742 = Hospital System Supply Identifier | 877192 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054743","type":"LOCAL"},{"code":"877193","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054743 = Hospital System Supply Identifier | 877193 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054748","type":"LOCAL"},{"code":"877198","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054748 = Hospital System Supply Identifier | 877198 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X14MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054746","type":"LOCAL"},{"code":"877196","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054746 = Hospital System Supply Identifier | 877196 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054747","type":"LOCAL"},{"code":"877197","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054747 = Hospital System Supply Identifier | 877197 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X10MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054744","type":"LOCAL"},{"code":"877194","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054744 = Hospital System Supply Identifier | 877194 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X12MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054745","type":"LOCAL"},{"code":"877195","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054745 = Hospital System Supply Identifier | 877195 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054749","type":"LOCAL"},{"code":"877199","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054749 = Hospital System Supply Identifier | 877199 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054750","type":"LOCAL"},{"code":"877200","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054750 = Hospital System Supply Identifier | 877200 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054751","type":"LOCAL"},{"code":"877201","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054751 = Hospital System Supply Identifier | 877201 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054752","type":"LOCAL"},{"code":"877202","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054752 = Hospital System Supply Identifier | 877202 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054753","type":"LOCAL"},{"code":"877203","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054753 = Hospital System Supply Identifier | 877203 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054757","type":"LOCAL"},{"code":"877207","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054757 = Hospital System Supply Identifier | 877207 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054758","type":"LOCAL"},{"code":"877208","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054758 = Hospital System Supply Identifier | 877208 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054755","type":"LOCAL"},{"code":"877205","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054755 = Hospital System Supply Identifier | 877205 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054754","type":"LOCAL"},{"code":"877204","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054754 = Hospital System Supply Identifier | 877204 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054756","type":"LOCAL"},{"code":"877206","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054756 = Hospital System Supply Identifier | 877206 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054759","type":"LOCAL"},{"code":"877209","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054759 = Hospital System Supply Identifier | 877209 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054760","type":"LOCAL"},{"code":"877210","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054760 = Hospital System Supply Identifier | 877210 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054761","type":"LOCAL"},{"code":"877211","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054761 = Hospital System Supply Identifier | 877211 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054765","type":"LOCAL"},{"code":"877215","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054765 = Hospital System Supply Identifier | 877215 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054764","type":"LOCAL"},{"code":"877214","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054764 = Hospital System Supply Identifier | 877214 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054766","type":"LOCAL"},{"code":"877216","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054766 = Hospital System Supply Identifier | 877216 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054762","type":"LOCAL"},{"code":"877212","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054762 = Hospital System Supply Identifier | 877212 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054763","type":"LOCAL"},{"code":"877213","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054763 = Hospital System Supply Identifier | 877213 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054771","type":"LOCAL"},{"code":"877221","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054771 = Hospital System Supply Identifier | 877221 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054770","type":"LOCAL"},{"code":"877220","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054770 = Hospital System Supply Identifier | 877220 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054767","type":"LOCAL"},{"code":"877217","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054767 = Hospital System Supply Identifier | 877217 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054768","type":"LOCAL"},{"code":"877218","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054768 = Hospital System Supply Identifier | 877218 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054769","type":"LOCAL"},{"code":"877219","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054769 = Hospital System Supply Identifier | 877219 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054772","type":"LOCAL"},{"code":"877222","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054772 = Hospital System Supply Identifier | 877222 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054773","type":"LOCAL"},{"code":"877223","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054773 = Hospital System Supply Identifier | 877223 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054774","type":"LOCAL"},{"code":"877224","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054774 = Hospital System Supply Identifier | 877224 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054775","type":"LOCAL"},{"code":"877225","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054775 = Hospital System Supply Identifier | 877225 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054776","type":"LOCAL"},{"code":"877226","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054776 = Hospital System Supply Identifier | 877226 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054781","type":"LOCAL"},{"code":"877231","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054781 = Hospital System Supply Identifier | 877231 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054780","type":"LOCAL"},{"code":"877230","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054780 = Hospital System Supply Identifier | 877230 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054778","type":"LOCAL"},{"code":"877228","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054778 = Hospital System Supply Identifier | 877228 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054777","type":"LOCAL"},{"code":"877227","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054777 = Hospital System Supply Identifier | 877227 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054779","type":"LOCAL"},{"code":"877229","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054779 = Hospital System Supply Identifier | 877229 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054782","type":"LOCAL"},{"code":"877232","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054782 = Hospital System Supply Identifier | 877232 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054783","type":"LOCAL"},{"code":"877233","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054783 = Hospital System Supply Identifier | 877233 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054784","type":"LOCAL"},{"code":"877234","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054784 = Hospital System Supply Identifier | 877234 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054785","type":"LOCAL"},{"code":"877235","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054785 = Hospital System Supply Identifier | 877235 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054786","type":"LOCAL"},{"code":"877236","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054786 = Hospital System Supply Identifier | 877236 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054791","type":"LOCAL"},{"code":"877241","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054791 = Hospital System Supply Identifier | 877241 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054789","type":"LOCAL"},{"code":"877239","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054789 = Hospital System Supply Identifier | 877239 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054790","type":"LOCAL"},{"code":"877240","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054790 = Hospital System Supply Identifier | 877240 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054787","type":"LOCAL"},{"code":"877237","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054787 = Hospital System Supply Identifier | 877237 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054788","type":"LOCAL"},{"code":"877238","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054788 = Hospital System Supply Identifier | 877238 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054792","type":"LOCAL"},{"code":"877242","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054792 = Hospital System Supply Identifier | 877242 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054793","type":"LOCAL"},{"code":"877243","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054793 = Hospital System Supply Identifier | 877243 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054794","type":"LOCAL"},{"code":"877244","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054794 = Hospital System Supply Identifier | 877244 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054795","type":"LOCAL"},{"code":"877245","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054795 = Hospital System Supply Identifier | 877245 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054796","type":"LOCAL"},{"code":"877246","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054796 = Hospital System Supply Identifier | 877246 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054798","type":"LOCAL"},{"code":"877248","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054798 = Hospital System Supply Identifier | 877248 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054797","type":"LOCAL"},{"code":"877247","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054797 = Hospital System Supply Identifier | 877247 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054799","type":"LOCAL"},{"code":"877249","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054799 = Hospital System Supply Identifier | 877249 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054800","type":"LOCAL"},{"code":"877250","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054800 = Hospital System Supply Identifier | 877250 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054801","type":"LOCAL"},{"code":"877251","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054801 = Hospital System Supply Identifier | 877251 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054802","type":"LOCAL"},{"code":"877252","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054802 = Hospital System Supply Identifier | 877252 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054803","type":"LOCAL"},{"code":"877253","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054803 = Hospital System Supply Identifier | 877253 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054804","type":"LOCAL"},{"code":"877254","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054804 = Hospital System Supply Identifier | 877254 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054809","type":"LOCAL"},{"code":"877259","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054809 = Hospital System Supply Identifier | 877259 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054807","type":"LOCAL"},{"code":"877257","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054807 = Hospital System Supply Identifier | 877257 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054808","type":"LOCAL"},{"code":"877258","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054808 = Hospital System Supply Identifier | 877258 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054805","type":"LOCAL"},{"code":"877255","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054805 = Hospital System Supply Identifier | 877255 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054806","type":"LOCAL"},{"code":"877256","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054806 = Hospital System Supply Identifier | 877256 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054810","type":"LOCAL"},{"code":"877260","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054810 = Hospital System Supply Identifier | 877260 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054811","type":"LOCAL"},{"code":"877261","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054811 = Hospital System Supply Identifier | 877261 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054812","type":"LOCAL"},{"code":"877262","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054812 = Hospital System Supply Identifier | 877262 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054813","type":"LOCAL"},{"code":"877263","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054813 = Hospital System Supply Identifier | 877263 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054814","type":"LOCAL"},{"code":"877264","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054814 = Hospital System Supply Identifier | 877264 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054817","type":"LOCAL"},{"code":"877267","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054817 = Hospital System Supply Identifier | 877267 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054819","type":"LOCAL"},{"code":"877269","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054819 = Hospital System Supply Identifier | 877269 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054818","type":"LOCAL"},{"code":"877268","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054818 = Hospital System Supply Identifier | 877268 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054816","type":"LOCAL"},{"code":"877266","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054816 = Hospital System Supply Identifier | 877266 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054815","type":"LOCAL"},{"code":"877265","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054815 = Hospital System Supply Identifier | 877265 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054820","type":"LOCAL"},{"code":"877270","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054820 = Hospital System Supply Identifier | 877270 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054821","type":"LOCAL"},{"code":"877271","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054821 = Hospital System Supply Identifier | 877271 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054822","type":"LOCAL"},{"code":"877272","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054822 = Hospital System Supply Identifier | 877272 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054823","type":"LOCAL"},{"code":"877273","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054823 = Hospital System Supply Identifier | 877273 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054824","type":"LOCAL"},{"code":"877274","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054824 = Hospital System Supply Identifier | 877274 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054826","type":"LOCAL"},{"code":"877276","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054826 = Hospital System Supply Identifier | 877276 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054825","type":"LOCAL"},{"code":"877275","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054825 = Hospital System Supply Identifier | 877275 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054827","type":"LOCAL"},{"code":"877277","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054827 = Hospital System Supply Identifier | 877277 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054832","type":"LOCAL"},{"code":"877282","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054832 = Hospital System Supply Identifier | 877282 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054831","type":"LOCAL"},{"code":"877281","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054831 = Hospital System Supply Identifier | 877281 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054829","type":"LOCAL"},{"code":"877279","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054829 = Hospital System Supply Identifier | 877279 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X14MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054830","type":"LOCAL"},{"code":"877280","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054830 = Hospital System Supply Identifier | 877280 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054828","type":"LOCAL"},{"code":"877278","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054828 = Hospital System Supply Identifier | 877278 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054833","type":"LOCAL"},{"code":"877283","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054833 = Hospital System Supply Identifier | 877283 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054834","type":"LOCAL"},{"code":"877284","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054834 = Hospital System Supply Identifier | 877284 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054835","type":"LOCAL"},{"code":"877285","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054835 = Hospital System Supply Identifier | 877285 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054836","type":"LOCAL"},{"code":"877286","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054836 = Hospital System Supply Identifier | 877286 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054837","type":"LOCAL"},{"code":"877287","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054837 = Hospital System Supply Identifier | 877287 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054842","type":"LOCAL"},{"code":"877292","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054842 = Hospital System Supply Identifier | 877292 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054841","type":"LOCAL"},{"code":"877291","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054841 = Hospital System Supply Identifier | 877291 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054840","type":"LOCAL"},{"code":"877290","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054840 = Hospital System Supply Identifier | 877290 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054839","type":"LOCAL"},{"code":"877289","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054839 = Hospital System Supply Identifier | 877289 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054838","type":"LOCAL"},{"code":"877288","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054838 = Hospital System Supply Identifier | 877288 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054843","type":"LOCAL"},{"code":"877293","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054843 = Hospital System Supply Identifier | 877293 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054844","type":"LOCAL"},{"code":"877294","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054844 = Hospital System Supply Identifier | 877294 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054845","type":"LOCAL"},{"code":"877295","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054845 = Hospital System Supply Identifier | 877295 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054846","type":"LOCAL"},{"code":"877296","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054846 = Hospital System Supply Identifier | 877296 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054847","type":"LOCAL"},{"code":"877297","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054847 = Hospital System Supply Identifier | 877297 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054852","type":"LOCAL"},{"code":"877302","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054852 = Hospital System Supply Identifier | 877302 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054851","type":"LOCAL"},{"code":"877301","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054851 = Hospital System Supply Identifier | 877301 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054850","type":"LOCAL"},{"code":"877300","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054850 = Hospital System Supply Identifier | 877300 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054849","type":"LOCAL"},{"code":"877299","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054849 = Hospital System Supply Identifier | 877299 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054848","type":"LOCAL"},{"code":"877298","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054848 = Hospital System Supply Identifier | 877298 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054853","type":"LOCAL"},{"code":"877303","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054853 = Hospital System Supply Identifier | 877303 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054854","type":"LOCAL"},{"code":"877304","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054854 = Hospital System Supply Identifier | 877304 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054855","type":"LOCAL"},{"code":"877305","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054855 = Hospital System Supply Identifier | 877305 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054856","type":"LOCAL"},{"code":"877306","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054856 = Hospital System Supply Identifier | 877306 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054857","type":"LOCAL"},{"code":"877307","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054857 = Hospital System Supply Identifier | 877307 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054858","type":"LOCAL"},{"code":"877308","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054858 = Hospital System Supply Identifier | 877308 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054859","type":"LOCAL"},{"code":"877309","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054859 = Hospital System Supply Identifier | 877309 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054860","type":"LOCAL"},{"code":"877310","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054860 = Hospital System Supply Identifier | 877310 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054861","type":"LOCAL"},{"code":"877311","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054861 = Hospital System Supply Identifier | 877311 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054862","type":"LOCAL"},{"code":"877312","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054862 = Hospital System Supply Identifier | 877312 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054863","type":"LOCAL"},{"code":"877313","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054863 = Hospital System Supply Identifier | 877313 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054864","type":"LOCAL"},{"code":"877314","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054864 = Hospital System Supply Identifier | 877314 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054865","type":"LOCAL"},{"code":"877315","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054865 = Hospital System Supply Identifier | 877315 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054866","type":"LOCAL"},{"code":"877316","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054866 = Hospital System Supply Identifier | 877316 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054867","type":"LOCAL"},{"code":"877317","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054867 = Hospital System Supply Identifier | 877317 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054871","type":"LOCAL"},{"code":"877321","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054871 = Hospital System Supply Identifier | 877321 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054870","type":"LOCAL"},{"code":"877320","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054870 = Hospital System Supply Identifier | 877320 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054872","type":"LOCAL"},{"code":"877322","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054872 = Hospital System Supply Identifier | 877322 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054868","type":"LOCAL"},{"code":"877318","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054868 = Hospital System Supply Identifier | 877318 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054869","type":"LOCAL"},{"code":"877319","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054869 = Hospital System Supply Identifier | 877319 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054877","type":"LOCAL"},{"code":"877327","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054877 = Hospital System Supply Identifier | 877327 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054876","type":"LOCAL"},{"code":"877326","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054876 = Hospital System Supply Identifier | 877326 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054873","type":"LOCAL"},{"code":"877323","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054873 = Hospital System Supply Identifier | 877323 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054874","type":"LOCAL"},{"code":"877324","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054874 = Hospital System Supply Identifier | 877324 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054875","type":"LOCAL"},{"code":"877325","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054875 = Hospital System Supply Identifier | 877325 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054878","type":"LOCAL"},{"code":"877328","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054878 = Hospital System Supply Identifier | 877328 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054879","type":"LOCAL"},{"code":"877329","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054879 = Hospital System Supply Identifier | 877329 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054880","type":"LOCAL"},{"code":"877330","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054880 = Hospital System Supply Identifier | 877330 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054884","type":"LOCAL"},{"code":"877334","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054884 = Hospital System Supply Identifier | 877334 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054882","type":"LOCAL"},{"code":"877332","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054882 = Hospital System Supply Identifier | 877332 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054883","type":"LOCAL"},{"code":"877333","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054883 = Hospital System Supply Identifier | 877333 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED SHORT-THREAD STERILE","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357223","type":"LOCAL"},{"code":"1083674","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357223 = Hospital System Supply Identifier | 1083674 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054881","type":"LOCAL"},{"code":"877331","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054881 = Hospital System Supply Identifier | 877331 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054885","type":"LOCAL"},{"code":"877335","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054885 = Hospital System Supply Identifier | 877335 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054886","type":"LOCAL"},{"code":"877336","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054886 = Hospital System Supply Identifier | 877336 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054887","type":"LOCAL"},{"code":"877337","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054887 = Hospital System Supply Identifier | 877337 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054888","type":"LOCAL"},{"code":"877338","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054888 = Hospital System Supply Identifier | 877338 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054889","type":"LOCAL"},{"code":"877339","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054889 = Hospital System Supply Identifier | 877339 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054894","type":"LOCAL"},{"code":"877344","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054894 = Hospital System Supply Identifier | 877344 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054892","type":"LOCAL"},{"code":"877342","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054892 = Hospital System Supply Identifier | 877342 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054893","type":"LOCAL"},{"code":"877343","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054893 = Hospital System Supply Identifier | 877343 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054890","type":"LOCAL"},{"code":"877340","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054890 = Hospital System Supply Identifier | 877340 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054891","type":"LOCAL"},{"code":"877341","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054891 = Hospital System Supply Identifier | 877341 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054895","type":"LOCAL"},{"code":"877345","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054895 = Hospital System Supply Identifier | 877345 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054896","type":"LOCAL"},{"code":"877346","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054896 = Hospital System Supply Identifier | 877346 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054897","type":"LOCAL"},{"code":"877347","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054897 = Hospital System Supply Identifier | 877347 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054898","type":"LOCAL"},{"code":"877348","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054898 = Hospital System Supply Identifier | 877348 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054899","type":"LOCAL"},{"code":"877349","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054899 = Hospital System Supply Identifier | 877349 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054904","type":"LOCAL"},{"code":"877354","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054904 = Hospital System Supply Identifier | 877354 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054903","type":"LOCAL"},{"code":"877353","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054903 = Hospital System Supply Identifier | 877353 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054902","type":"LOCAL"},{"code":"877352","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054902 = Hospital System Supply Identifier | 877352 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054900","type":"LOCAL"},{"code":"877350","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054900 = Hospital System Supply Identifier | 877350 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054901","type":"LOCAL"},{"code":"877351","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054901 = Hospital System Supply Identifier | 877351 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054905","type":"LOCAL"},{"code":"877355","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054905 = Hospital System Supply Identifier | 877355 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054906","type":"LOCAL"},{"code":"877356","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054906 = Hospital System Supply Identifier | 877356 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054907","type":"LOCAL"},{"code":"877357","type":"LOCAL"}],"standard_charges":[{"gross_charge":735.8,"discounted_cash":551.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054907 = Hospital System Supply Identifier | 877357 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X14MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054908","type":"LOCAL"},{"code":"877358","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054908 = Hospital System Supply Identifier | 877358 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054909","type":"LOCAL"},{"code":"877359","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054909 = Hospital System Supply Identifier | 877359 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054910","type":"LOCAL"},{"code":"877360","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054910 = Hospital System Supply Identifier | 877360 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054915","type":"LOCAL"},{"code":"877365","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054915 = Hospital System Supply Identifier | 877365 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054913","type":"LOCAL"},{"code":"877363","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054913 = Hospital System Supply Identifier | 877363 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054914","type":"LOCAL"},{"code":"877364","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054914 = Hospital System Supply Identifier | 877364 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054911","type":"LOCAL"},{"code":"877361","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054911 = Hospital System Supply Identifier | 877361 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054912","type":"LOCAL"},{"code":"877362","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054912 = Hospital System Supply Identifier | 877362 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054916","type":"LOCAL"},{"code":"877366","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054916 = Hospital System Supply Identifier | 877366 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054917","type":"LOCAL"},{"code":"877367","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054917 = Hospital System Supply Identifier | 877367 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054918","type":"LOCAL"},{"code":"877368","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054918 = Hospital System Supply Identifier | 877368 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054919","type":"LOCAL"},{"code":"877369","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054919 = Hospital System Supply Identifier | 877369 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054920","type":"LOCAL"},{"code":"877370","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054920 = Hospital System Supply Identifier | 877370 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054925","type":"LOCAL"},{"code":"877375","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054925 = Hospital System Supply Identifier | 877375 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054924","type":"LOCAL"},{"code":"877374","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054924 = Hospital System Supply Identifier | 877374 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054921","type":"LOCAL"},{"code":"877371","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054921 = Hospital System Supply Identifier | 877371 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054922","type":"LOCAL"},{"code":"877372","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054922 = Hospital System Supply Identifier | 877372 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054923","type":"LOCAL"},{"code":"877373","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054923 = Hospital System Supply Identifier | 877373 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054926","type":"LOCAL"},{"code":"877376","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054926 = Hospital System Supply Identifier | 877376 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054927","type":"LOCAL"},{"code":"877377","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054927 = Hospital System Supply Identifier | 877377 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054928","type":"LOCAL"},{"code":"877378","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054928 = Hospital System Supply Identifier | 877378 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054929","type":"LOCAL"},{"code":"877379","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054929 = Hospital System Supply Identifier | 877379 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054930","type":"LOCAL"},{"code":"877380","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054930 = Hospital System Supply Identifier | 877380 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054932","type":"LOCAL"},{"code":"877382","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054932 = Hospital System Supply Identifier | 877382 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054931","type":"LOCAL"},{"code":"877381","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054931 = Hospital System Supply Identifier | 877381 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054934","type":"LOCAL"},{"code":"877384","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054934 = Hospital System Supply Identifier | 877384 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054933","type":"LOCAL"},{"code":"877383","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054933 = Hospital System Supply Identifier | 877383 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054935","type":"LOCAL"},{"code":"877385","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054935 = Hospital System Supply Identifier | 877385 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054936","type":"LOCAL"},{"code":"877386","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054936 = Hospital System Supply Identifier | 877386 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054937","type":"LOCAL"},{"code":"877387","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054937 = Hospital System Supply Identifier | 877387 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054938","type":"LOCAL"},{"code":"877388","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054938 = Hospital System Supply Identifier | 877388 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054939","type":"LOCAL"},{"code":"877389","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054939 = Hospital System Supply Identifier | 877389 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054940","type":"LOCAL"},{"code":"877390","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054940 = Hospital System Supply Identifier | 877390 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054941","type":"LOCAL"},{"code":"877391","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054941 = Hospital System Supply Identifier | 877391 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054942","type":"LOCAL"},{"code":"877392","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054942 = Hospital System Supply Identifier | 877392 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054943","type":"LOCAL"},{"code":"877393","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054943 = Hospital System Supply Identifier | 877393 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054948","type":"LOCAL"},{"code":"877398","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054948 = Hospital System Supply Identifier | 877398 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054947","type":"LOCAL"},{"code":"877397","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054947 = Hospital System Supply Identifier | 877397 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054944","type":"LOCAL"},{"code":"877394","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054944 = Hospital System Supply Identifier | 877394 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054945","type":"LOCAL"},{"code":"877395","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054945 = Hospital System Supply Identifier | 877395 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054946","type":"LOCAL"},{"code":"877396","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054946 = Hospital System Supply Identifier | 877396 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054952","type":"LOCAL"},{"code":"877402","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054952 = Hospital System Supply Identifier | 877402 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054949","type":"LOCAL"},{"code":"877399","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054949 = Hospital System Supply Identifier | 877399 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054950","type":"LOCAL"},{"code":"877400","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054950 = Hospital System Supply Identifier | 877400 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054951","type":"LOCAL"},{"code":"877401","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054951 = Hospital System Supply Identifier | 877401 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054953","type":"LOCAL"},{"code":"877403","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054953 = Hospital System Supply Identifier | 877403 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054955","type":"LOCAL"},{"code":"877405","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054955 = Hospital System Supply Identifier | 877405 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054954","type":"LOCAL"},{"code":"877404","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054954 = Hospital System Supply Identifier | 877404 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054957","type":"LOCAL"},{"code":"877407","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054957 = Hospital System Supply Identifier | 877407 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054956","type":"LOCAL"},{"code":"877406","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054956 = Hospital System Supply Identifier | 877406 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054958","type":"LOCAL"},{"code":"877408","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054958 = Hospital System Supply Identifier | 877408 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054959","type":"LOCAL"},{"code":"877409","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054959 = Hospital System Supply Identifier | 877409 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054960","type":"LOCAL"},{"code":"877410","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054960 = Hospital System Supply Identifier | 877410 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054961","type":"LOCAL"},{"code":"877411","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054961 = Hospital System Supply Identifier | 877411 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054962","type":"LOCAL"},{"code":"877412","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054962 = Hospital System Supply Identifier | 877412 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054963","type":"LOCAL"},{"code":"877413","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054963 = Hospital System Supply Identifier | 877413 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054964","type":"LOCAL"},{"code":"877414","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054964 = Hospital System Supply Identifier | 877414 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054965","type":"LOCAL"},{"code":"877415","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054965 = Hospital System Supply Identifier | 877415 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054970","type":"LOCAL"},{"code":"877420","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054970 = Hospital System Supply Identifier | 877420 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054969","type":"LOCAL"},{"code":"877419","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054969 = Hospital System Supply Identifier | 877419 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054967","type":"LOCAL"},{"code":"877417","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054967 = Hospital System Supply Identifier | 877417 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054966","type":"LOCAL"},{"code":"877416","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054966 = Hospital System Supply Identifier | 877416 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054968","type":"LOCAL"},{"code":"877418","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054968 = Hospital System Supply Identifier | 877418 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054971","type":"LOCAL"},{"code":"877421","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054971 = Hospital System Supply Identifier | 877421 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054972","type":"LOCAL"},{"code":"877422","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054972 = Hospital System Supply Identifier | 877422 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054973","type":"LOCAL"},{"code":"877423","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054973 = Hospital System Supply Identifier | 877423 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054974","type":"LOCAL"},{"code":"877424","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054974 = Hospital System Supply Identifier | 877424 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054975","type":"LOCAL"},{"code":"877425","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054975 = Hospital System Supply Identifier | 877425 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054980","type":"LOCAL"},{"code":"877430","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054980 = Hospital System Supply Identifier | 877430 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054979","type":"LOCAL"},{"code":"877429","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054979 = Hospital System Supply Identifier | 877429 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054977","type":"LOCAL"},{"code":"877427","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054977 = Hospital System Supply Identifier | 877427 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054976","type":"LOCAL"},{"code":"877426","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054976 = Hospital System Supply Identifier | 877426 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054978","type":"LOCAL"},{"code":"877428","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054978 = Hospital System Supply Identifier | 877428 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054981","type":"LOCAL"},{"code":"877431","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054981 = Hospital System Supply Identifier | 877431 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054982","type":"LOCAL"},{"code":"877432","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054982 = Hospital System Supply Identifier | 877432 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054983","type":"LOCAL"},{"code":"877433","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054983 = Hospital System Supply Identifier | 877433 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054984","type":"LOCAL"},{"code":"877434","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054984 = Hospital System Supply Identifier | 877434 = Lawson ID"}]},{"description":"SCREW CANN P/T 4.5X80MM","code_information":[{"code":"Sx00-1400-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054985","type":"LOCAL"},{"code":"877435","type":"LOCAL"}],"standard_charges":[{"gross_charge":792.4,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054985 = Hospital System Supply Identifier | 877435 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054988","type":"LOCAL"},{"code":"877438","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054988 = Hospital System Supply Identifier | 877438 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054990","type":"LOCAL"},{"code":"877440","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054990 = Hospital System Supply Identifier | 877440 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054989","type":"LOCAL"},{"code":"877439","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054989 = Hospital System Supply Identifier | 877439 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054987","type":"LOCAL"},{"code":"877437","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054987 = Hospital System Supply Identifier | 877437 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054986","type":"LOCAL"},{"code":"877436","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054986 = Hospital System Supply Identifier | 877436 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054991","type":"LOCAL"},{"code":"877441","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054991 = Hospital System Supply Identifier | 877441 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054992","type":"LOCAL"},{"code":"877442","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054992 = Hospital System Supply Identifier | 877442 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054993","type":"LOCAL"},{"code":"877443","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054993 = Hospital System Supply Identifier | 877443 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054994","type":"LOCAL"},{"code":"877444","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054994 = Hospital System Supply Identifier | 877444 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054995","type":"LOCAL"},{"code":"877445","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054995 = Hospital System Supply Identifier | 877445 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055000","type":"LOCAL"},{"code":"877450","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055000 = Hospital System Supply Identifier | 877450 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054999","type":"LOCAL"},{"code":"877449","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054999 = Hospital System Supply Identifier | 877449 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054997","type":"LOCAL"},{"code":"877447","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054997 = Hospital System Supply Identifier | 877447 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054998","type":"LOCAL"},{"code":"877448","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054998 = Hospital System Supply Identifier | 877448 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054996","type":"LOCAL"},{"code":"877446","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1054996 = Hospital System Supply Identifier | 877446 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055001","type":"LOCAL"},{"code":"877451","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055001 = Hospital System Supply Identifier | 877451 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055002","type":"LOCAL"},{"code":"877452","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055002 = Hospital System Supply Identifier | 877452 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055003","type":"LOCAL"},{"code":"877453","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055003 = Hospital System Supply Identifier | 877453 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055004","type":"LOCAL"},{"code":"877454","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055004 = Hospital System Supply Identifier | 877454 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055005","type":"LOCAL"},{"code":"877455","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055005 = Hospital System Supply Identifier | 877455 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055006","type":"LOCAL"},{"code":"877456","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055006 = Hospital System Supply Identifier | 877456 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055008","type":"LOCAL"},{"code":"877458","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055008 = Hospital System Supply Identifier | 877458 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055007","type":"LOCAL"},{"code":"877457","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055007 = Hospital System Supply Identifier | 877457 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055009","type":"LOCAL"},{"code":"877459","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055009 = Hospital System Supply Identifier | 877459 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055010","type":"LOCAL"},{"code":"877460","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055010 = Hospital System Supply Identifier | 877460 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055011","type":"LOCAL"},{"code":"877461","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055011 = Hospital System Supply Identifier | 877461 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055012","type":"LOCAL"},{"code":"877462","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055012 = Hospital System Supply Identifier | 877462 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055013","type":"LOCAL"},{"code":"877463","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055013 = Hospital System Supply Identifier | 877463 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055014","type":"LOCAL"},{"code":"877464","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055014 = Hospital System Supply Identifier | 877464 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055016","type":"LOCAL"},{"code":"877466","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055016 = Hospital System Supply Identifier | 877466 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055015","type":"LOCAL"},{"code":"877465","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055015 = Hospital System Supply Identifier | 877465 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055018","type":"LOCAL"},{"code":"877468","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055018 = Hospital System Supply Identifier | 877468 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055017","type":"LOCAL"},{"code":"877467","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055017 = Hospital System Supply Identifier | 877467 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055019","type":"LOCAL"},{"code":"877469","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055019 = Hospital System Supply Identifier | 877469 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055020","type":"LOCAL"},{"code":"877470","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055020 = Hospital System Supply Identifier | 877470 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055021","type":"LOCAL"},{"code":"877471","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055021 = Hospital System Supply Identifier | 877471 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055022","type":"LOCAL"},{"code":"877472","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055022 = Hospital System Supply Identifier | 877472 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055023","type":"LOCAL"},{"code":"877473","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055023 = Hospital System Supply Identifier | 877473 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055024","type":"LOCAL"},{"code":"877474","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055024 = Hospital System Supply Identifier | 877474 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055025","type":"LOCAL"},{"code":"877475","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055025 = Hospital System Supply Identifier | 877475 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055030","type":"LOCAL"},{"code":"877480","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055030 = Hospital System Supply Identifier | 877480 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055029","type":"LOCAL"},{"code":"877479","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055029 = Hospital System Supply Identifier | 877479 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055027","type":"LOCAL"},{"code":"877477","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055027 = Hospital System Supply Identifier | 877477 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055026","type":"LOCAL"},{"code":"877476","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055026 = Hospital System Supply Identifier | 877476 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055028","type":"LOCAL"},{"code":"877478","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055028 = Hospital System Supply Identifier | 877478 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055034","type":"LOCAL"},{"code":"877484","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055034 = Hospital System Supply Identifier | 877484 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055031","type":"LOCAL"},{"code":"877481","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055031 = Hospital System Supply Identifier | 877481 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055032","type":"LOCAL"},{"code":"877482","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055032 = Hospital System Supply Identifier | 877482 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055033","type":"LOCAL"},{"code":"877483","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055033 = Hospital System Supply Identifier | 877483 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055035","type":"LOCAL"},{"code":"877485","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055035 = Hospital System Supply Identifier | 877485 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055039","type":"LOCAL"},{"code":"877489","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055039 = Hospital System Supply Identifier | 877489 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055038","type":"LOCAL"},{"code":"877488","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055038 = Hospital System Supply Identifier | 877488 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055040","type":"LOCAL"},{"code":"877490","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055040 = Hospital System Supply Identifier | 877490 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055036","type":"LOCAL"},{"code":"877486","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055036 = Hospital System Supply Identifier | 877486 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055037","type":"LOCAL"},{"code":"877487","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055037 = Hospital System Supply Identifier | 877487 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055041","type":"LOCAL"},{"code":"877491","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055041 = Hospital System Supply Identifier | 877491 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055042","type":"LOCAL"},{"code":"877492","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055042 = Hospital System Supply Identifier | 877492 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055043","type":"LOCAL"},{"code":"877493","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055043 = Hospital System Supply Identifier | 877493 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055044","type":"LOCAL"},{"code":"877494","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055044 = Hospital System Supply Identifier | 877494 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055045","type":"LOCAL"},{"code":"877495","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055045 = Hospital System Supply Identifier | 877495 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055046","type":"LOCAL"},{"code":"877496","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055046 = Hospital System Supply Identifier | 877496 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055047","type":"LOCAL"},{"code":"877497","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055047 = Hospital System Supply Identifier | 877497 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055048","type":"LOCAL"},{"code":"877498","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055048 = Hospital System Supply Identifier | 877498 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055050","type":"LOCAL"},{"code":"877500","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055050 = Hospital System Supply Identifier | 877500 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055049","type":"LOCAL"},{"code":"877499","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055049 = Hospital System Supply Identifier | 877499 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055051","type":"LOCAL"},{"code":"877501","type":"LOCAL"}],"standard_charges":[{"gross_charge":891.45,"discounted_cash":668.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055051 = Hospital System Supply Identifier | 877501 = Lawson ID"}]},{"description":"SCREW-WASHER CANN 6.5/7.3MM","code_information":[{"code":"Sx00-1402-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055052","type":"LOCAL"},{"code":"877502","type":"LOCAL"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":106.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055052 = Hospital System Supply Identifier | 877502 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X30","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055053","type":"LOCAL"},{"code":"877503","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055053 = Hospital System Supply Identifier | 877503 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X35","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055054","type":"LOCAL"},{"code":"877504","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055054 = Hospital System Supply Identifier | 877504 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X40","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055055","type":"LOCAL"},{"code":"877505","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055055 = Hospital System Supply Identifier | 877505 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X45","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055056","type":"LOCAL"},{"code":"877506","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055056 = Hospital System Supply Identifier | 877506 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X50","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055057","type":"LOCAL"},{"code":"877507","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055057 = Hospital System Supply Identifier | 877507 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X55","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055058","type":"LOCAL"},{"code":"877508","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055058 = Hospital System Supply Identifier | 877508 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X65","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055060","type":"LOCAL"},{"code":"877510","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055060 = Hospital System Supply Identifier | 877510 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X60","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055059","type":"LOCAL"},{"code":"877509","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055059 = Hospital System Supply Identifier | 877509 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X70","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055061","type":"LOCAL"},{"code":"877511","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055061 = Hospital System Supply Identifier | 877511 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X75","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055062","type":"LOCAL"},{"code":"877512","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055062 = Hospital System Supply Identifier | 877512 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X80","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055063","type":"LOCAL"},{"code":"877513","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055063 = Hospital System Supply Identifier | 877513 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X85","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055064","type":"LOCAL"},{"code":"877514","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055064 = Hospital System Supply Identifier | 877514 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X90","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055065","type":"LOCAL"},{"code":"877515","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055065 = Hospital System Supply Identifier | 877515 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X95","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055066","type":"LOCAL"},{"code":"877516","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055066 = Hospital System Supply Identifier | 877516 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X100","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055067","type":"LOCAL"},{"code":"877517","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055067 = Hospital System Supply Identifier | 877517 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X105","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055068","type":"LOCAL"},{"code":"877518","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055068 = Hospital System Supply Identifier | 877518 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X115","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055070","type":"LOCAL"},{"code":"877520","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055070 = Hospital System Supply Identifier | 877520 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X110","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055069","type":"LOCAL"},{"code":"877519","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055069 = Hospital System Supply Identifier | 877519 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X120","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055071","type":"LOCAL"},{"code":"877521","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055071 = Hospital System Supply Identifier | 877521 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X125","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055072","type":"LOCAL"},{"code":"877522","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055072 = Hospital System Supply Identifier | 877522 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X130","code_information":[{"code":"Sx00-1402-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055073","type":"LOCAL"},{"code":"877523","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055073 = Hospital System Supply Identifier | 877523 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X30","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055074","type":"LOCAL"},{"code":"877524","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055074 = Hospital System Supply Identifier | 877524 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X32","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055075","type":"LOCAL"},{"code":"877525","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055075 = Hospital System Supply Identifier | 877525 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X34","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055076","type":"LOCAL"},{"code":"877526","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055076 = Hospital System Supply Identifier | 877526 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X36","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055077","type":"LOCAL"},{"code":"877527","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055077 = Hospital System Supply Identifier | 877527 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X38","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055078","type":"LOCAL"},{"code":"877528","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055078 = Hospital System Supply Identifier | 877528 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X46","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055082","type":"LOCAL"},{"code":"877532","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055082 = Hospital System Supply Identifier | 877532 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X48","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055083","type":"LOCAL"},{"code":"877533","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055083 = Hospital System Supply Identifier | 877533 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X44","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055081","type":"LOCAL"},{"code":"877531","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055081 = Hospital System Supply Identifier | 877531 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X40","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055079","type":"LOCAL"},{"code":"877529","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055079 = Hospital System Supply Identifier | 877529 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X42","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055080","type":"LOCAL"},{"code":"877530","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055080 = Hospital System Supply Identifier | 877530 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X50","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055084","type":"LOCAL"},{"code":"877534","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055084 = Hospital System Supply Identifier | 877534 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X52","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055085","type":"LOCAL"},{"code":"877535","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055085 = Hospital System Supply Identifier | 877535 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X54","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055086","type":"LOCAL"},{"code":"877536","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055086 = Hospital System Supply Identifier | 877536 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X56","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055087","type":"LOCAL"},{"code":"877537","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055087 = Hospital System Supply Identifier | 877537 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X58","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055088","type":"LOCAL"},{"code":"877538","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055088 = Hospital System Supply Identifier | 877538 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X68","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055095","type":"LOCAL"},{"code":"877543","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055095 = Hospital System Supply Identifier | 877543 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X66","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055094","type":"LOCAL"},{"code":"877542","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055094 = Hospital System Supply Identifier | 877542 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X64","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055093","type":"LOCAL"},{"code":"877541","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055093 = Hospital System Supply Identifier | 877541 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X60","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055089","type":"LOCAL"},{"code":"877539","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055089 = Hospital System Supply Identifier | 877539 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X62","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055090","type":"LOCAL"},{"code":"877540","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055090 = Hospital System Supply Identifier | 877540 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X70","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055096","type":"LOCAL"},{"code":"877544","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055096 = Hospital System Supply Identifier | 877544 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X72","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055097","type":"LOCAL"},{"code":"877545","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055097 = Hospital System Supply Identifier | 877545 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X74","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055098","type":"LOCAL"},{"code":"877546","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055098 = Hospital System Supply Identifier | 877546 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X76","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055099","type":"LOCAL"},{"code":"877547","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055099 = Hospital System Supply Identifier | 877547 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X78","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055100","type":"LOCAL"},{"code":"877548","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055100 = Hospital System Supply Identifier | 877548 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X88","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055105","type":"LOCAL"},{"code":"877553","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055105 = Hospital System Supply Identifier | 877553 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X84","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055103","type":"LOCAL"},{"code":"877551","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055103 = Hospital System Supply Identifier | 877551 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X86","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055104","type":"LOCAL"},{"code":"877552","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055104 = Hospital System Supply Identifier | 877552 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X80","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055101","type":"LOCAL"},{"code":"877549","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055101 = Hospital System Supply Identifier | 877549 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X82","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055102","type":"LOCAL"},{"code":"877550","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055102 = Hospital System Supply Identifier | 877550 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X90","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055106","type":"LOCAL"},{"code":"877554","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055106 = Hospital System Supply Identifier | 877554 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X95","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055107","type":"LOCAL"},{"code":"877555","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055107 = Hospital System Supply Identifier | 877555 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X100","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055108","type":"LOCAL"},{"code":"877556","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055108 = Hospital System Supply Identifier | 877556 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X105","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055109","type":"LOCAL"},{"code":"877557","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055109 = Hospital System Supply Identifier | 877557 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X110","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055110","type":"LOCAL"},{"code":"877558","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055110 = Hospital System Supply Identifier | 877558 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X115","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055111","type":"LOCAL"},{"code":"877559","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055111 = Hospital System Supply Identifier | 877559 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X120","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055112","type":"LOCAL"},{"code":"877560","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055112 = Hospital System Supply Identifier | 877560 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X125","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055113","type":"LOCAL"},{"code":"877561","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055113 = Hospital System Supply Identifier | 877561 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X130","code_information":[{"code":"Sx00-1402-213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055114","type":"LOCAL"},{"code":"877562","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055114 = Hospital System Supply Identifier | 877562 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X30","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055115","type":"LOCAL"},{"code":"877563","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055115 = Hospital System Supply Identifier | 877563 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X35","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055116","type":"LOCAL"},{"code":"877564","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055116 = Hospital System Supply Identifier | 877564 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X40","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055117","type":"LOCAL"},{"code":"877565","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055117 = Hospital System Supply Identifier | 877565 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X45","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055118","type":"LOCAL"},{"code":"877566","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055118 = Hospital System Supply Identifier | 877566 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X50","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055119","type":"LOCAL"},{"code":"877567","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055119 = Hospital System Supply Identifier | 877567 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X55","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055120","type":"LOCAL"},{"code":"877568","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055120 = Hospital System Supply Identifier | 877568 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X60","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055121","type":"LOCAL"},{"code":"877569","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055121 = Hospital System Supply Identifier | 877569 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X65","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055122","type":"LOCAL"},{"code":"877570","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055122 = Hospital System Supply Identifier | 877570 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X70","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055123","type":"LOCAL"},{"code":"877571","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055123 = Hospital System Supply Identifier | 877571 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X75","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055124","type":"LOCAL"},{"code":"877572","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055124 = Hospital System Supply Identifier | 877572 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X85","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055126","type":"LOCAL"},{"code":"877574","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055126 = Hospital System Supply Identifier | 877574 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X80","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055125","type":"LOCAL"},{"code":"877573","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055125 = Hospital System Supply Identifier | 877573 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X90","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055127","type":"LOCAL"},{"code":"877575","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055127 = Hospital System Supply Identifier | 877575 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X95","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055128","type":"LOCAL"},{"code":"877576","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055128 = Hospital System Supply Identifier | 877576 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X100","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055129","type":"LOCAL"},{"code":"877577","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055129 = Hospital System Supply Identifier | 877577 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X105","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055130","type":"LOCAL"},{"code":"877578","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055130 = Hospital System Supply Identifier | 877578 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X110","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055131","type":"LOCAL"},{"code":"877579","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055131 = Hospital System Supply Identifier | 877579 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X115","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055132","type":"LOCAL"},{"code":"877580","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055132 = Hospital System Supply Identifier | 877580 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X120","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055133","type":"LOCAL"},{"code":"877581","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055133 = Hospital System Supply Identifier | 877581 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X125","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055134","type":"LOCAL"},{"code":"877582","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055134 = Hospital System Supply Identifier | 877582 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X130","code_information":[{"code":"Sx00-1402-513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055135","type":"LOCAL"},{"code":"877583","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055135 = Hospital System Supply Identifier | 877583 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X38","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055140","type":"LOCAL"},{"code":"877588","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055140 = Hospital System Supply Identifier | 877588 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X36","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055139","type":"LOCAL"},{"code":"877587","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055139 = Hospital System Supply Identifier | 877587 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X32","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055137","type":"LOCAL"},{"code":"877585","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055137 = Hospital System Supply Identifier | 877585 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X30","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055136","type":"LOCAL"},{"code":"877584","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055136 = Hospital System Supply Identifier | 877584 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X34","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055138","type":"LOCAL"},{"code":"877586","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055138 = Hospital System Supply Identifier | 877586 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X40","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055141","type":"LOCAL"},{"code":"877589","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055141 = Hospital System Supply Identifier | 877589 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X42","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055142","type":"LOCAL"},{"code":"877590","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055142 = Hospital System Supply Identifier | 877590 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X44","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055143","type":"LOCAL"},{"code":"877591","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055143 = Hospital System Supply Identifier | 877591 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X46","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055144","type":"LOCAL"},{"code":"877592","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055144 = Hospital System Supply Identifier | 877592 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X48","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055145","type":"LOCAL"},{"code":"877593","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055145 = Hospital System Supply Identifier | 877593 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X58","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055150","type":"LOCAL"},{"code":"877598","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055150 = Hospital System Supply Identifier | 877598 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X56","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055149","type":"LOCAL"},{"code":"877597","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055149 = Hospital System Supply Identifier | 877597 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X50","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055146","type":"LOCAL"},{"code":"877594","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055146 = Hospital System Supply Identifier | 877594 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X52","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055147","type":"LOCAL"},{"code":"877595","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055147 = Hospital System Supply Identifier | 877595 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X54","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055148","type":"LOCAL"},{"code":"877596","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055148 = Hospital System Supply Identifier | 877596 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X60","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055151","type":"LOCAL"},{"code":"877599","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055151 = Hospital System Supply Identifier | 877599 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X62","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055152","type":"LOCAL"},{"code":"877600","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055152 = Hospital System Supply Identifier | 877600 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X64","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055153","type":"LOCAL"},{"code":"877601","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055153 = Hospital System Supply Identifier | 877601 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X66","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055154","type":"LOCAL"},{"code":"877602","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055154 = Hospital System Supply Identifier | 877602 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X68","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055155","type":"LOCAL"},{"code":"877603","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055155 = Hospital System Supply Identifier | 877603 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X78","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055160","type":"LOCAL"},{"code":"877608","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055160 = Hospital System Supply Identifier | 877608 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X76","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055159","type":"LOCAL"},{"code":"877607","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055159 = Hospital System Supply Identifier | 877607 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X72","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055157","type":"LOCAL"},{"code":"877605","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055157 = Hospital System Supply Identifier | 877605 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X70","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055156","type":"LOCAL"},{"code":"877604","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055156 = Hospital System Supply Identifier | 877604 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X74","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055158","type":"LOCAL"},{"code":"877606","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055158 = Hospital System Supply Identifier | 877606 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X86","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055164","type":"LOCAL"},{"code":"877612","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055164 = Hospital System Supply Identifier | 877612 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X80","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055161","type":"LOCAL"},{"code":"877609","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055161 = Hospital System Supply Identifier | 877609 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X82","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055162","type":"LOCAL"},{"code":"877610","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055162 = Hospital System Supply Identifier | 877610 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X84","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055163","type":"LOCAL"},{"code":"877611","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055163 = Hospital System Supply Identifier | 877611 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X88","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055165","type":"LOCAL"},{"code":"877613","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055165 = Hospital System Supply Identifier | 877613 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X95","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055167","type":"LOCAL"},{"code":"877615","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055167 = Hospital System Supply Identifier | 877615 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X90","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055166","type":"LOCAL"},{"code":"877614","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055166 = Hospital System Supply Identifier | 877614 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X100","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055168","type":"LOCAL"},{"code":"877616","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055168 = Hospital System Supply Identifier | 877616 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X105","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055169","type":"LOCAL"},{"code":"877617","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055169 = Hospital System Supply Identifier | 877617 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X110","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055170","type":"LOCAL"},{"code":"877618","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055170 = Hospital System Supply Identifier | 877618 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X115","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055171","type":"LOCAL"},{"code":"877619","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055171 = Hospital System Supply Identifier | 877619 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X120","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055172","type":"LOCAL"},{"code":"877620","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055172 = Hospital System Supply Identifier | 877620 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X125","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055173","type":"LOCAL"},{"code":"877621","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055173 = Hospital System Supply Identifier | 877621 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X130","code_information":[{"code":"Sx00-1402-613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055174","type":"LOCAL"},{"code":"877622","type":"LOCAL"}],"standard_charges":[{"gross_charge":976.35,"discounted_cash":732.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055174 = Hospital System Supply Identifier | 877622 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026345 SS 6.5X45MM","code_information":[{"code":"Sx00-1402-634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357242","type":"LOCAL"},{"code":"1082486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357242 = Hospital System Supply Identifier | 1082486 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356515","type":"LOCAL"},{"code":"1083660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356515 = Hospital System Supply Identifier | 1083660 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026355 SS 6.5X55MM","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356332","type":"LOCAL"},{"code":"1082535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356332 = Hospital System Supply Identifier | 1082535 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026365 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356734","type":"LOCAL"},{"code":"1082540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356734 = Hospital System Supply Identifier | 1082540 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356855","type":"LOCAL"},{"code":"1083704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356855 = Hospital System Supply Identifier | 1083704 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026375 SS 6.5X75MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356629","type":"LOCAL"},{"code":"1082532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356629 = Hospital System Supply Identifier | 1082532 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026370 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356840","type":"LOCAL"},{"code":"1082597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356840 = Hospital System Supply Identifier | 1082597 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026385 SS 6.5X85MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356911","type":"LOCAL"},{"code":"1082513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356911 = Hospital System Supply Identifier | 1082513 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026380 SS 6.5X80MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357051","type":"LOCAL"},{"code":"1082559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357051 = Hospital System Supply Identifier | 1082559 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026390 SS 6.5X90MM","code_information":[{"code":"Sx00-1402-639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356965","type":"LOCAL"},{"code":"1082507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356965 = Hospital System Supply Identifier | 1082507 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027065 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356731","type":"LOCAL"},{"code":"1082443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356731 = Hospital System Supply Identifier | 1082443 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027075 SS 7.3X75MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357033","type":"LOCAL"},{"code":"1082521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357033 = Hospital System Supply Identifier | 1082521 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027070 SS 7.3X70MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356427","type":"LOCAL"},{"code":"1082456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356427 = Hospital System Supply Identifier | 1082456 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027085 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356967","type":"LOCAL"},{"code":"1082545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356967 = Hospital System Supply Identifier | 1082545 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356499","type":"LOCAL"},{"code":"1083619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356499 = Hospital System Supply Identifier | 1083619 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027095 SS 7.3X95MM","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356612","type":"LOCAL"},{"code":"1082428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356612 = Hospital System Supply Identifier | 1082428 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356378","type":"LOCAL"},{"code":"1083550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356378 = Hospital System Supply Identifier | 1083550 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027100 SS 7.3X100MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356636","type":"LOCAL"},{"code":"1082474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356636 = Hospital System Supply Identifier | 1082474 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027105 SS 7.3X105MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356713","type":"LOCAL"},{"code":"1082581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356713 = Hospital System Supply Identifier | 1082581 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027110 SS 7.3X110MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356555","type":"LOCAL"},{"code":"1082449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356555 = Hospital System Supply Identifier | 1082449 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027115 SS 7.3X115MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356592","type":"LOCAL"},{"code":"1082543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356592 = Hospital System Supply Identifier | 1082543 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027125 SS 7.3X125MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356613","type":"LOCAL"},{"code":"1082445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356613 = Hospital System Supply Identifier | 1082445 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027120 SS 7.3X120MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356503","type":"LOCAL"},{"code":"1082432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356503 = Hospital System Supply Identifier | 1082432 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027130 SS 7.3X130MM","code_information":[{"code":"Sx00-1402-713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357080","type":"LOCAL"},{"code":"1082554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357080 = Hospital System Supply Identifier | 1082554 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027345 SS 7.3X45MM","code_information":[{"code":"Sx00-1402-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356707","type":"LOCAL"},{"code":"1082530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356707 = Hospital System Supply Identifier | 1082530 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027350 SS 7.3X50MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357078","type":"LOCAL"},{"code":"1082509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357078 = Hospital System Supply Identifier | 1082509 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027355 SS 7.3X55MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357111","type":"LOCAL"},{"code":"1082517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357111 = Hospital System Supply Identifier | 1082517 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027365 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356374","type":"LOCAL"},{"code":"1082476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356374 = Hospital System Supply Identifier | 1082476 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027360 SS 7.3X60MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356693","type":"LOCAL"},{"code":"1082595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356693 = Hospital System Supply Identifier | 1082595 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356846","type":"LOCAL"},{"code":"1083727","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356846 = Hospital System Supply Identifier | 1083727 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357224","type":"LOCAL"},{"code":"1083728","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357224 = Hospital System Supply Identifier | 1083728 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356746","type":"LOCAL"},{"code":"1083554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356746 = Hospital System Supply Identifier | 1083554 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027385 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356606","type":"LOCAL"},{"code":"1082504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356606 = Hospital System Supply Identifier | 1082504 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356621","type":"LOCAL"},{"code":"1083548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356621 = Hospital System Supply Identifier | 1083548 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028065 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356689","type":"LOCAL"},{"code":"1082566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356689 = Hospital System Supply Identifier | 1082566 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028070 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356571","type":"LOCAL"},{"code":"1082550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356571 = Hospital System Supply Identifier | 1082550 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356344","type":"LOCAL"},{"code":"1083712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356344 = Hospital System Supply Identifier | 1083712 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356519","type":"LOCAL"},{"code":"1083556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356519 = Hospital System Supply Identifier | 1083556 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356488","type":"LOCAL"},{"code":"1083658","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356488 = Hospital System Supply Identifier | 1083658 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028095 SS 6.5X95MM","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356834","type":"LOCAL"},{"code":"1082480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356834 = Hospital System Supply Identifier | 1082480 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356858","type":"LOCAL"},{"code":"1083535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356858 = Hospital System Supply Identifier | 1083535 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028105 SS 6.5X105MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356992","type":"LOCAL"},{"code":"1082485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356992 = Hospital System Supply Identifier | 1082485 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028100 SS 6.5X100MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356935","type":"LOCAL"},{"code":"1082560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356935 = Hospital System Supply Identifier | 1082560 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028115 SS 6.5X115MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356984","type":"LOCAL"},{"code":"1082460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356984 = Hospital System Supply Identifier | 1082460 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028110 SS 6.5X110MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356960","type":"LOCAL"},{"code":"1082441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356960 = Hospital System Supply Identifier | 1082441 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028125 SS 6.5X125MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356799","type":"LOCAL"},{"code":"1082430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356799 = Hospital System Supply Identifier | 1082430 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028120 SS 6.5X120MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357029","type":"LOCAL"},{"code":"1082431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357029 = Hospital System Supply Identifier | 1082431 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028130 SS 6.5X130MM","code_information":[{"code":"Sx00-1402-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356672","type":"LOCAL"},{"code":"1082457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":856.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356672 = Hospital System Supply Identifier | 1082457 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055175","type":"LOCAL"},{"code":"877623","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055175 = Hospital System Supply Identifier | 877623 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055176","type":"LOCAL"},{"code":"877624","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055176 = Hospital System Supply Identifier | 877624 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055177","type":"LOCAL"},{"code":"877625","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055177 = Hospital System Supply Identifier | 877625 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055178","type":"LOCAL"},{"code":"877626","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055178 = Hospital System Supply Identifier | 877626 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055179","type":"LOCAL"},{"code":"877627","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055179 = Hospital System Supply Identifier | 877627 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055184","type":"LOCAL"},{"code":"877632","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055184 = Hospital System Supply Identifier | 877632 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055183","type":"LOCAL"},{"code":"877631","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055183 = Hospital System Supply Identifier | 877631 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055181","type":"LOCAL"},{"code":"877629","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055181 = Hospital System Supply Identifier | 877629 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055180","type":"LOCAL"},{"code":"877628","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055180 = Hospital System Supply Identifier | 877628 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055182","type":"LOCAL"},{"code":"877630","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055182 = Hospital System Supply Identifier | 877630 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055185","type":"LOCAL"},{"code":"877633","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055185 = Hospital System Supply Identifier | 877633 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055186","type":"LOCAL"},{"code":"877634","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055186 = Hospital System Supply Identifier | 877634 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055187","type":"LOCAL"},{"code":"877635","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055187 = Hospital System Supply Identifier | 877635 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055191","type":"LOCAL"},{"code":"877639","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055191 = Hospital System Supply Identifier | 877639 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055188","type":"LOCAL"},{"code":"877636","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055188 = Hospital System Supply Identifier | 877636 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055189","type":"LOCAL"},{"code":"877637","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055189 = Hospital System Supply Identifier | 877637 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055190","type":"LOCAL"},{"code":"877638","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055190 = Hospital System Supply Identifier | 877638 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055192","type":"LOCAL"},{"code":"877640","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055192 = Hospital System Supply Identifier | 877640 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055193","type":"LOCAL"},{"code":"877641","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055193 = Hospital System Supply Identifier | 877641 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055194","type":"LOCAL"},{"code":"877642","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055194 = Hospital System Supply Identifier | 877642 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM LT","code_information":[{"code":"Sx00-1501-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055195","type":"LOCAL"},{"code":"877643","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055195 = Hospital System Supply Identifier | 877643 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055198","type":"LOCAL"},{"code":"877646","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055198 = Hospital System Supply Identifier | 877646 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055199","type":"LOCAL"},{"code":"877647","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055199 = Hospital System Supply Identifier | 877647 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055196","type":"LOCAL"},{"code":"877644","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055196 = Hospital System Supply Identifier | 877644 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055197","type":"LOCAL"},{"code":"877645","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055197 = Hospital System Supply Identifier | 877645 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055200","type":"LOCAL"},{"code":"877648","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055200 = Hospital System Supply Identifier | 877648 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055202","type":"LOCAL"},{"code":"877650","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055202 = Hospital System Supply Identifier | 877650 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055201","type":"LOCAL"},{"code":"877649","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055201 = Hospital System Supply Identifier | 877649 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 0MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055203","type":"LOCAL"},{"code":"877651","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055203 = Hospital System Supply Identifier | 877651 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 5MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055204","type":"LOCAL"},{"code":"877652","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055204 = Hospital System Supply Identifier | 877652 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 10MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055205","type":"LOCAL"},{"code":"877653","type":"LOCAL"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":274.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055205 = Hospital System Supply Identifier | 877653 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 15MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055206","type":"LOCAL"},{"code":"877654","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055206 = Hospital System Supply Identifier | 877654 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 20MM","code_information":[{"code":"Sx00-1501-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055207","type":"LOCAL"},{"code":"877655","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055207 = Hospital System Supply Identifier | 877655 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356506","type":"LOCAL"},{"code":"1083649","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356506 = Hospital System Supply Identifier | 1083649 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356557","type":"LOCAL"},{"code":"1083709","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356557 = Hospital System Supply Identifier | 1083709 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357038","type":"LOCAL"},{"code":"1083692","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357038 = Hospital System Supply Identifier | 1083692 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357184","type":"LOCAL"},{"code":"1083705","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357184 = Hospital System Supply Identifier | 1083705 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356875","type":"LOCAL"},{"code":"1083573","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356875 = Hospital System Supply Identifier | 1083573 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055208","type":"LOCAL"},{"code":"877656","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055208 = Hospital System Supply Identifier | 877656 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055209","type":"LOCAL"},{"code":"877657","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055209 = Hospital System Supply Identifier | 877657 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055210","type":"LOCAL"},{"code":"877658","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055210 = Hospital System Supply Identifier | 877658 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055211","type":"LOCAL"},{"code":"877659","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055211 = Hospital System Supply Identifier | 877659 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055212","type":"LOCAL"},{"code":"877660","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055212 = Hospital System Supply Identifier | 877660 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055217","type":"LOCAL"},{"code":"877665","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055217 = Hospital System Supply Identifier | 877665 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055215","type":"LOCAL"},{"code":"877663","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055215 = Hospital System Supply Identifier | 877663 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055216","type":"LOCAL"},{"code":"877664","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055216 = Hospital System Supply Identifier | 877664 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055213","type":"LOCAL"},{"code":"877661","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055213 = Hospital System Supply Identifier | 877661 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055214","type":"LOCAL"},{"code":"877662","type":"LOCAL"}],"standard_charges":[{"gross_charge":11298.0,"discounted_cash":8473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055214 = Hospital System Supply Identifier | 877662 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055218","type":"LOCAL"},{"code":"877666","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055218 = Hospital System Supply Identifier | 877666 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055219","type":"LOCAL"},{"code":"877667","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055219 = Hospital System Supply Identifier | 877667 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055220","type":"LOCAL"},{"code":"877668","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055220 = Hospital System Supply Identifier | 877668 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055224","type":"LOCAL"},{"code":"877672","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055224 = Hospital System Supply Identifier | 877672 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055221","type":"LOCAL"},{"code":"877669","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055221 = Hospital System Supply Identifier | 877669 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055222","type":"LOCAL"},{"code":"877670","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055222 = Hospital System Supply Identifier | 877670 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055223","type":"LOCAL"},{"code":"877671","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055223 = Hospital System Supply Identifier | 877671 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055225","type":"LOCAL"},{"code":"877673","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055225 = Hospital System Supply Identifier | 877673 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055227","type":"LOCAL"},{"code":"877675","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055227 = Hospital System Supply Identifier | 877675 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055226","type":"LOCAL"},{"code":"877674","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055226 = Hospital System Supply Identifier | 877674 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM RT","code_information":[{"code":"Sx00-1502-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055228","type":"LOCAL"},{"code":"877676","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055228 = Hospital System Supply Identifier | 877676 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055229","type":"LOCAL"},{"code":"877677","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055229 = Hospital System Supply Identifier | 877677 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055230","type":"LOCAL"},{"code":"877678","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055230 = Hospital System Supply Identifier | 877678 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055231","type":"LOCAL"},{"code":"877679","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055231 = Hospital System Supply Identifier | 877679 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055232","type":"LOCAL"},{"code":"877680","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055232 = Hospital System Supply Identifier | 877680 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055233","type":"LOCAL"},{"code":"877681","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055233 = Hospital System Supply Identifier | 877681 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055235","type":"LOCAL"},{"code":"877683","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055235 = Hospital System Supply Identifier | 877683 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055234","type":"LOCAL"},{"code":"877682","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055234 = Hospital System Supply Identifier | 877682 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM LT","code_information":[{"code":"Sx00-1503-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055236","type":"LOCAL"},{"code":"877684","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055236 = Hospital System Supply Identifier | 877684 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055241","type":"LOCAL"},{"code":"877689","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055241 = Hospital System Supply Identifier | 877689 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055239","type":"LOCAL"},{"code":"877687","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055239 = Hospital System Supply Identifier | 877687 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055240","type":"LOCAL"},{"code":"877688","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055240 = Hospital System Supply Identifier | 877688 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055238","type":"LOCAL"},{"code":"877686","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055238 = Hospital System Supply Identifier | 877686 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055237","type":"LOCAL"},{"code":"877685","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055237 = Hospital System Supply Identifier | 877685 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357264","type":"LOCAL"},{"code":"1083571","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357264 = Hospital System Supply Identifier | 1083571 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356973","type":"LOCAL"},{"code":"1083596","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356973 = Hospital System Supply Identifier | 1083596 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357236","type":"LOCAL"},{"code":"1083657","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357236 = Hospital System Supply Identifier | 1083657 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055242","type":"LOCAL"},{"code":"877690","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055242 = Hospital System Supply Identifier | 877690 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055243","type":"LOCAL"},{"code":"877691","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055243 = Hospital System Supply Identifier | 877691 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055248","type":"LOCAL"},{"code":"877696","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055248 = Hospital System Supply Identifier | 877696 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055247","type":"LOCAL"},{"code":"877695","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055247 = Hospital System Supply Identifier | 877695 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055246","type":"LOCAL"},{"code":"877694","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055246 = Hospital System Supply Identifier | 877694 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055245","type":"LOCAL"},{"code":"877693","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055245 = Hospital System Supply Identifier | 877693 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055244","type":"LOCAL"},{"code":"877692","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055244 = Hospital System Supply Identifier | 877692 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357221","type":"LOCAL"},{"code":"1083647","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357221 = Hospital System Supply Identifier | 1083647 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356354","type":"LOCAL"},{"code":"1083680","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356354 = Hospital System Supply Identifier | 1083680 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356802","type":"LOCAL"},{"code":"1083713","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356802 = Hospital System Supply Identifier | 1083713 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055249","type":"LOCAL"},{"code":"877697","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055249 = Hospital System Supply Identifier | 877697 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055250","type":"LOCAL"},{"code":"877698","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055250 = Hospital System Supply Identifier | 877698 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055255","type":"LOCAL"},{"code":"877703","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055255 = Hospital System Supply Identifier | 877703 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055254","type":"LOCAL"},{"code":"877702","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055254 = Hospital System Supply Identifier | 877702 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055253","type":"LOCAL"},{"code":"877701","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055253 = Hospital System Supply Identifier | 877701 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055252","type":"LOCAL"},{"code":"877700","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055252 = Hospital System Supply Identifier | 877700 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055251","type":"LOCAL"},{"code":"877699","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055251 = Hospital System Supply Identifier | 877699 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356623","type":"LOCAL"},{"code":"1083577","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356623 = Hospital System Supply Identifier | 1083577 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356725","type":"LOCAL"},{"code":"1083611","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356725 = Hospital System Supply Identifier | 1083611 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356500","type":"LOCAL"},{"code":"1083662","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356500 = Hospital System Supply Identifier | 1083662 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055256","type":"LOCAL"},{"code":"877704","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055256 = Hospital System Supply Identifier | 877704 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055257","type":"LOCAL"},{"code":"877705","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055257 = Hospital System Supply Identifier | 877705 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055262","type":"LOCAL"},{"code":"877710","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055262 = Hospital System Supply Identifier | 877710 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055261","type":"LOCAL"},{"code":"877709","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055261 = Hospital System Supply Identifier | 877709 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055260","type":"LOCAL"},{"code":"877708","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055260 = Hospital System Supply Identifier | 877708 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055259","type":"LOCAL"},{"code":"877707","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055259 = Hospital System Supply Identifier | 877707 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055258","type":"LOCAL"},{"code":"877706","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055258 = Hospital System Supply Identifier | 877706 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356764","type":"LOCAL"},{"code":"1083552","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356764 = Hospital System Supply Identifier | 1083552 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356697","type":"LOCAL"},{"code":"1083726","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356697 = Hospital System Supply Identifier | 1083726 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357204","type":"LOCAL"},{"code":"1083751","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357204 = Hospital System Supply Identifier | 1083751 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055263","type":"LOCAL"},{"code":"877711","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055263 = Hospital System Supply Identifier | 877711 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055264","type":"LOCAL"},{"code":"877712","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055264 = Hospital System Supply Identifier | 877712 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 0MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055265","type":"LOCAL"},{"code":"877713","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055265 = Hospital System Supply Identifier | 877713 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 5MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055266","type":"LOCAL"},{"code":"877714","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055266 = Hospital System Supply Identifier | 877714 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 15MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055268","type":"LOCAL"},{"code":"877716","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055268 = Hospital System Supply Identifier | 877716 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 10MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055267","type":"LOCAL"},{"code":"877715","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055267 = Hospital System Supply Identifier | 877715 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 20MM","code_information":[{"code":"Sx00-1503-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055269","type":"LOCAL"},{"code":"877717","type":"LOCAL"}],"standard_charges":[{"gross_charge":483.45,"discounted_cash":362.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055269 = Hospital System Supply Identifier | 877717 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356718","type":"LOCAL"},{"code":"1083654","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356718 = Hospital System Supply Identifier | 1083654 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356353","type":"LOCAL"},{"code":"1083667","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356353 = Hospital System Supply Identifier | 1083667 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356972","type":"LOCAL"},{"code":"1083561","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356972 = Hospital System Supply Identifier | 1083561 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357122","type":"LOCAL"},{"code":"1083609","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357122 = Hospital System Supply Identifier | 1083609 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356626","type":"LOCAL"},{"code":"1083677","type":"LOCAL"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":562.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356626 = Hospital System Supply Identifier | 1083677 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM RT","code_information":[{"code":"Sx00-1504-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055270","type":"LOCAL"},{"code":"877718","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055270 = Hospital System Supply Identifier | 877718 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055275","type":"LOCAL"},{"code":"877723","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055275 = Hospital System Supply Identifier | 877723 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055274","type":"LOCAL"},{"code":"877722","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055274 = Hospital System Supply Identifier | 877722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055273","type":"LOCAL"},{"code":"877721","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055273 = Hospital System Supply Identifier | 877721 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055272","type":"LOCAL"},{"code":"877720","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055272 = Hospital System Supply Identifier | 877720 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055271","type":"LOCAL"},{"code":"877719","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055271 = Hospital System Supply Identifier | 877719 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356513","type":"LOCAL"},{"code":"1083557","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356513 = Hospital System Supply Identifier | 1083557 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356518","type":"LOCAL"},{"code":"1083574","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356518 = Hospital System Supply Identifier | 1083574 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356339","type":"LOCAL"},{"code":"1083734","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356339 = Hospital System Supply Identifier | 1083734 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055276","type":"LOCAL"},{"code":"877724","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055276 = Hospital System Supply Identifier | 877724 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055277","type":"LOCAL"},{"code":"877725","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055277 = Hospital System Supply Identifier | 877725 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055282","type":"LOCAL"},{"code":"877730","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055282 = Hospital System Supply Identifier | 877730 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055281","type":"LOCAL"},{"code":"877729","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055281 = Hospital System Supply Identifier | 877729 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055280","type":"LOCAL"},{"code":"877728","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055280 = Hospital System Supply Identifier | 877728 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055279","type":"LOCAL"},{"code":"877727","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055279 = Hospital System Supply Identifier | 877727 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055278","type":"LOCAL"},{"code":"877726","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055278 = Hospital System Supply Identifier | 877726 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356379","type":"LOCAL"},{"code":"1083555","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356379 = Hospital System Supply Identifier | 1083555 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356950","type":"LOCAL"},{"code":"1083653","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356950 = Hospital System Supply Identifier | 1083653 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356719","type":"LOCAL"},{"code":"1083666","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356719 = Hospital System Supply Identifier | 1083666 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055283","type":"LOCAL"},{"code":"877731","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055283 = Hospital System Supply Identifier | 877731 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055284","type":"LOCAL"},{"code":"877732","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055284 = Hospital System Supply Identifier | 877732 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055289","type":"LOCAL"},{"code":"877737","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055289 = Hospital System Supply Identifier | 877737 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055288","type":"LOCAL"},{"code":"877736","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055288 = Hospital System Supply Identifier | 877736 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055287","type":"LOCAL"},{"code":"877735","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055287 = Hospital System Supply Identifier | 877735 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055286","type":"LOCAL"},{"code":"877734","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055286 = Hospital System Supply Identifier | 877734 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055285","type":"LOCAL"},{"code":"877733","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055285 = Hospital System Supply Identifier | 877733 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356747","type":"LOCAL"},{"code":"1083543","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356747 = Hospital System Supply Identifier | 1083543 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356971","type":"LOCAL"},{"code":"1083602","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356971 = Hospital System Supply Identifier | 1083602 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356939","type":"LOCAL"},{"code":"1083722","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356939 = Hospital System Supply Identifier | 1083722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055290","type":"LOCAL"},{"code":"877738","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055290 = Hospital System Supply Identifier | 877738 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055291","type":"LOCAL"},{"code":"877739","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055291 = Hospital System Supply Identifier | 877739 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055296","type":"LOCAL"},{"code":"877744","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055296 = Hospital System Supply Identifier | 877744 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055294","type":"LOCAL"},{"code":"877742","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055294 = Hospital System Supply Identifier | 877742 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055295","type":"LOCAL"},{"code":"877743","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055295 = Hospital System Supply Identifier | 877743 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055293","type":"LOCAL"},{"code":"877741","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055293 = Hospital System Supply Identifier | 877741 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055292","type":"LOCAL"},{"code":"877740","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055292 = Hospital System Supply Identifier | 877740 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357120","type":"LOCAL"},{"code":"1083570","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357120 = Hospital System Supply Identifier | 1083570 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356729","type":"LOCAL"},{"code":"1083679","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356729 = Hospital System Supply Identifier | 1083679 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357084","type":"LOCAL"},{"code":"1083750","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357084 = Hospital System Supply Identifier | 1083750 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055297","type":"LOCAL"},{"code":"877745","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055297 = Hospital System Supply Identifier | 877745 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055298","type":"LOCAL"},{"code":"877746","type":"LOCAL"}],"standard_charges":[{"gross_charge":10530.0,"discounted_cash":7897.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055298 = Hospital System Supply Identifier | 877746 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X27.5MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055300","type":"LOCAL"},{"code":"877748","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055300 = Hospital System Supply Identifier | 877748 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X25MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055299","type":"LOCAL"},{"code":"877747","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055299 = Hospital System Supply Identifier | 877747 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X30MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055301","type":"LOCAL"},{"code":"877749","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055301 = Hospital System Supply Identifier | 877749 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X32.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055302","type":"LOCAL"},{"code":"877750","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055302 = Hospital System Supply Identifier | 877750 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X35MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055303","type":"LOCAL"},{"code":"877751","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055303 = Hospital System Supply Identifier | 877751 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X37.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055304","type":"LOCAL"},{"code":"877752","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055304 = Hospital System Supply Identifier | 877752 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X47.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055308","type":"LOCAL"},{"code":"877756","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055308 = Hospital System Supply Identifier | 877756 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X40MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055305","type":"LOCAL"},{"code":"877753","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055305 = Hospital System Supply Identifier | 877753 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X42.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055306","type":"LOCAL"},{"code":"877754","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055306 = Hospital System Supply Identifier | 877754 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X45MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055307","type":"LOCAL"},{"code":"877755","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055307 = Hospital System Supply Identifier | 877755 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X55MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055311","type":"LOCAL"},{"code":"877759","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055311 = Hospital System Supply Identifier | 877759 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X57.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055312","type":"LOCAL"},{"code":"877760","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055312 = Hospital System Supply Identifier | 877760 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X50MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055309","type":"LOCAL"},{"code":"877757","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055309 = Hospital System Supply Identifier | 877757 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X52.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055310","type":"LOCAL"},{"code":"877758","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055310 = Hospital System Supply Identifier | 877758 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X60MM","code_information":[{"code":"Sx00-1506-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055313","type":"LOCAL"},{"code":"877761","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055313 = Hospital System Supply Identifier | 877761 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356748","type":"LOCAL"},{"code":"1083546","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356748 = Hospital System Supply Identifier | 1083546 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356390","type":"LOCAL"},{"code":"1083583","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356390 = Hospital System Supply Identifier | 1083583 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356497","type":"LOCAL"},{"code":"1083562","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356497 = Hospital System Supply Identifier | 1083562 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356940","type":"LOCAL"},{"code":"1083737","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356940 = Hospital System Supply Identifier | 1083737 = Lawson ID"}]},{"description":"SCREW F/T 4.5X25MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055314","type":"LOCAL"},{"code":"877762","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055314 = Hospital System Supply Identifier | 877762 = Lawson ID"}]},{"description":"SCREW F/T 4.5X27.5MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055315","type":"LOCAL"},{"code":"877763","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055315 = Hospital System Supply Identifier | 877763 = Lawson ID"}]},{"description":"SCREW F/T 4.5X37.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055319","type":"LOCAL"},{"code":"877767","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055319 = Hospital System Supply Identifier | 877767 = Lawson ID"}]},{"description":"SCREW F/T 4.5X35MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055318","type":"LOCAL"},{"code":"877766","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055318 = Hospital System Supply Identifier | 877766 = Lawson ID"}]},{"description":"SCREW F/T 4.5X30MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055316","type":"LOCAL"},{"code":"877764","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055316 = Hospital System Supply Identifier | 877764 = Lawson ID"}]},{"description":"SCREW F/T 4.5X32.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055317","type":"LOCAL"},{"code":"877765","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055317 = Hospital System Supply Identifier | 877765 = Lawson ID"}]},{"description":"SCREW F/T 4.5X40MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055320","type":"LOCAL"},{"code":"877768","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055320 = Hospital System Supply Identifier | 877768 = Lawson ID"}]},{"description":"SCREW F/T 4.5X42.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055321","type":"LOCAL"},{"code":"877769","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055321 = Hospital System Supply Identifier | 877769 = Lawson ID"}]},{"description":"SCREW F/T 4.5X45MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055322","type":"LOCAL"},{"code":"877770","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055322 = Hospital System Supply Identifier | 877770 = Lawson ID"}]},{"description":"SCREW F/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055323","type":"LOCAL"},{"code":"877771","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055323 = Hospital System Supply Identifier | 877771 = Lawson ID"}]},{"description":"SCREW F/T 4.5X50MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055324","type":"LOCAL"},{"code":"877772","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055324 = Hospital System Supply Identifier | 877772 = Lawson ID"}]},{"description":"SCREW F/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055325","type":"LOCAL"},{"code":"877773","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055325 = Hospital System Supply Identifier | 877773 = Lawson ID"}]},{"description":"SCREW F/T 4.5X55MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055326","type":"LOCAL"},{"code":"877774","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055326 = Hospital System Supply Identifier | 877774 = Lawson ID"}]},{"description":"SCREW F/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055327","type":"LOCAL"},{"code":"877775","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055327 = Hospital System Supply Identifier | 877775 = Lawson ID"}]},{"description":"SCREW F/T 4.5X65MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055330","type":"LOCAL"},{"code":"877778","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055330 = Hospital System Supply Identifier | 877778 = Lawson ID"}]},{"description":"SCREW F/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055331","type":"LOCAL"},{"code":"877779","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055331 = Hospital System Supply Identifier | 877779 = Lawson ID"}]},{"description":"SCREW F/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055329","type":"LOCAL"},{"code":"877777","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055329 = Hospital System Supply Identifier | 877777 = Lawson ID"}]},{"description":"SCREW F/T 4.5X60MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055328","type":"LOCAL"},{"code":"877776","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055328 = Hospital System Supply Identifier | 877776 = Lawson ID"}]},{"description":"SCREW F/T 4.5X70MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055332","type":"LOCAL"},{"code":"877780","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055332 = Hospital System Supply Identifier | 877780 = Lawson ID"}]},{"description":"SCREW F/T 4.5X75MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055333","type":"LOCAL"},{"code":"877781","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055333 = Hospital System Supply Identifier | 877781 = Lawson ID"}]},{"description":"SCREW F/T 4.5X80MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055334","type":"LOCAL"},{"code":"877782","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055334 = Hospital System Supply Identifier | 877782 = Lawson ID"}]},{"description":"SCREW F/T 4.5X85MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055335","type":"LOCAL"},{"code":"877783","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055335 = Hospital System Supply Identifier | 877783 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356504","type":"LOCAL"},{"code":"1083581","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356504 = Hospital System Supply Identifier | 1083581 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357094","type":"LOCAL"},{"code":"1083696","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357094 = Hospital System Supply Identifier | 1083696 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356988","type":"LOCAL"},{"code":"1083582","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356988 = Hospital System Supply Identifier | 1083582 = Lawson ID"}]},{"description":"SCREW P/T 4.5X45MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055336","type":"LOCAL"},{"code":"877784","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055336 = Hospital System Supply Identifier | 877784 = Lawson ID"}]},{"description":"SCREW P/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055337","type":"LOCAL"},{"code":"877785","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055337 = Hospital System Supply Identifier | 877785 = Lawson ID"}]},{"description":"SCREW P/T 4.5X50MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055338","type":"LOCAL"},{"code":"877786","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055338 = Hospital System Supply Identifier | 877786 = Lawson ID"}]},{"description":"SCREW P/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055339","type":"LOCAL"},{"code":"877787","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055339 = Hospital System Supply Identifier | 877787 = Lawson ID"}]},{"description":"SCREW P/T 4.5X55MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055340","type":"LOCAL"},{"code":"877788","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055340 = Hospital System Supply Identifier | 877788 = Lawson ID"}]},{"description":"SCREW P/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055341","type":"LOCAL"},{"code":"877789","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055341 = Hospital System Supply Identifier | 877789 = Lawson ID"}]},{"description":"SCREW P/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055345","type":"LOCAL"},{"code":"877793","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055345 = Hospital System Supply Identifier | 877793 = Lawson ID"}]},{"description":"SCREW P/T 4.5X65MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055344","type":"LOCAL"},{"code":"877792","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055344 = Hospital System Supply Identifier | 877792 = Lawson ID"}]},{"description":"SCREW P/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055343","type":"LOCAL"},{"code":"877791","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055343 = Hospital System Supply Identifier | 877791 = Lawson ID"}]},{"description":"SCREW P/T 4.5X60MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055342","type":"LOCAL"},{"code":"877790","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055342 = Hospital System Supply Identifier | 877790 = Lawson ID"}]},{"description":"SCREW P/T 4.5X70MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055346","type":"LOCAL"},{"code":"877794","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055346 = Hospital System Supply Identifier | 877794 = Lawson ID"}]},{"description":"SCREW P/T 4.5X75MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055347","type":"LOCAL"},{"code":"877795","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055347 = Hospital System Supply Identifier | 877795 = Lawson ID"}]},{"description":"SCREW P/T 4.5X80MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055348","type":"LOCAL"},{"code":"877796","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055348 = Hospital System Supply Identifier | 877796 = Lawson ID"}]},{"description":"SCREW P/T 4.5X85MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055349","type":"LOCAL"},{"code":"877797","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055349 = Hospital System Supply Identifier | 877797 = Lawson ID"}]},{"description":"SCREW P/T 4.5X90MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055350","type":"LOCAL"},{"code":"877798","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055350 = Hospital System Supply Identifier | 877798 = Lawson ID"}]},{"description":"SCREW P/T 4.5X95MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055351","type":"LOCAL"},{"code":"877799","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055351 = Hospital System Supply Identifier | 877799 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357228","type":"LOCAL"},{"code":"1083731","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357228 = Hospital System Supply Identifier | 1083731 = Lawson ID"}]},{"description":"SCREW P/T 4.5X100MM","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055352","type":"LOCAL"},{"code":"877800","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055352 = Hospital System Supply Identifier | 877800 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356758","type":"LOCAL"},{"code":"1083595","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356758 = Hospital System Supply Identifier | 1083595 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356485","type":"LOCAL"},{"code":"1083715","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356485 = Hospital System Supply Identifier | 1083715 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356987","type":"LOCAL"},{"code":"1083540","type":"LOCAL"}],"standard_charges":[{"gross_charge":863.15,"discounted_cash":647.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356987 = Hospital System Supply Identifier | 1083540 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356974","type":"LOCAL"},{"code":"1083610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356974 = Hospital System Supply Identifier | 1083610 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357217","type":"LOCAL"},{"code":"1083711","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357217 = Hospital System Supply Identifier | 1083711 = Lawson ID"}]},{"description":"SCREW F/T 5.0X25MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055353","type":"LOCAL"},{"code":"877801","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055353 = Hospital System Supply Identifier | 877801 = Lawson ID"}]},{"description":"SCREW F/T 5.0X27.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055354","type":"LOCAL"},{"code":"877802","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055354 = Hospital System Supply Identifier | 877802 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED FEMORAL PNP FEMUR 0015064023 5.0X22.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356495","type":"LOCAL"},{"code":"1082572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356495 = Hospital System Supply Identifier | 1082572 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356720","type":"LOCAL"},{"code":"1083718","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356720 = Hospital System Supply Identifier | 1083718 = Lawson ID"}]},{"description":"SCREW F/T 5.0X35MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055357","type":"LOCAL"},{"code":"877805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055357 = Hospital System Supply Identifier | 877805 = Lawson ID"}]},{"description":"SCREW F/T 5.0X37.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055358","type":"LOCAL"},{"code":"877806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055358 = Hospital System Supply Identifier | 877806 = Lawson ID"}]},{"description":"SCREW F/T 5.0X30MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055355","type":"LOCAL"},{"code":"877803","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055355 = Hospital System Supply Identifier | 877803 = Lawson ID"}]},{"description":"SCREW F/T 5.0X32.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055356","type":"LOCAL"},{"code":"877804","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055356 = Hospital System Supply Identifier | 877804 = Lawson ID"}]},{"description":"SCREW F/T 5.0X45MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055361","type":"LOCAL"},{"code":"877809","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055361 = Hospital System Supply Identifier | 877809 = Lawson ID"}]},{"description":"SCREW F/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055362","type":"LOCAL"},{"code":"877810","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055362 = Hospital System Supply Identifier | 877810 = Lawson ID"}]},{"description":"SCREW F/T 5.0X40MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055359","type":"LOCAL"},{"code":"877807","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055359 = Hospital System Supply Identifier | 877807 = Lawson ID"}]},{"description":"SCREW F/T 5.0X42.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055360","type":"LOCAL"},{"code":"877808","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055360 = Hospital System Supply Identifier | 877808 = Lawson ID"}]},{"description":"SCREW F/T 5.0X50MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055363","type":"LOCAL"},{"code":"877811","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055363 = Hospital System Supply Identifier | 877811 = Lawson ID"}]},{"description":"SCREW F/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055364","type":"LOCAL"},{"code":"877812","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055364 = Hospital System Supply Identifier | 877812 = Lawson ID"}]},{"description":"SCREW F/T 5.0X55MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055365","type":"LOCAL"},{"code":"877813","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055365 = Hospital System Supply Identifier | 877813 = Lawson ID"}]},{"description":"SCREW F/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055366","type":"LOCAL"},{"code":"877814","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055366 = Hospital System Supply Identifier | 877814 = Lawson ID"}]},{"description":"SCREW F/T 5.0X60MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055367","type":"LOCAL"},{"code":"877815","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055367 = Hospital System Supply Identifier | 877815 = Lawson ID"}]},{"description":"SCREW F/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055368","type":"LOCAL"},{"code":"877816","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055368 = Hospital System Supply Identifier | 877816 = Lawson ID"}]},{"description":"SCREW F/T 5.0X65MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055369","type":"LOCAL"},{"code":"877817","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055369 = Hospital System Supply Identifier | 877817 = Lawson ID"}]},{"description":"SCREW F/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055370","type":"LOCAL"},{"code":"877818","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055370 = Hospital System Supply Identifier | 877818 = Lawson ID"}]},{"description":"SCREW F/T 5.0X75MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055372","type":"LOCAL"},{"code":"877820","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055372 = Hospital System Supply Identifier | 877820 = Lawson ID"}]},{"description":"SCREW F/T 5.0X70MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055371","type":"LOCAL"},{"code":"877819","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055371 = Hospital System Supply Identifier | 877819 = Lawson ID"}]},{"description":"SCREW F/T 5.0X80MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055373","type":"LOCAL"},{"code":"877821","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055373 = Hospital System Supply Identifier | 877821 = Lawson ID"}]},{"description":"SCREW F/T 5.0X85MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055374","type":"LOCAL"},{"code":"877822","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055374 = Hospital System Supply Identifier | 877822 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357127","type":"LOCAL"},{"code":"1083584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357127 = Hospital System Supply Identifier | 1083584 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356478","type":"LOCAL"},{"code":"1083738","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356478 = Hospital System Supply Identifier | 1083738 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356579","type":"LOCAL"},{"code":"1083720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356579 = Hospital System Supply Identifier | 1083720 = Lawson ID"}]},{"description":"SCREW P/T 5.0X45MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055375","type":"LOCAL"},{"code":"877823","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055375 = Hospital System Supply Identifier | 877823 = Lawson ID"}]},{"description":"SCREW P/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055376","type":"LOCAL"},{"code":"877824","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055376 = Hospital System Supply Identifier | 877824 = Lawson ID"}]},{"description":"SCREW P/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055380","type":"LOCAL"},{"code":"877828","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055380 = Hospital System Supply Identifier | 877828 = Lawson ID"}]},{"description":"SCREW P/T 5.0X55MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055379","type":"LOCAL"},{"code":"877827","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055379 = Hospital System Supply Identifier | 877827 = Lawson ID"}]},{"description":"SCREW P/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055378","type":"LOCAL"},{"code":"877826","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055378 = Hospital System Supply Identifier | 877826 = Lawson ID"}]},{"description":"SCREW P/T 5.0X50MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055377","type":"LOCAL"},{"code":"877825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055377 = Hospital System Supply Identifier | 877825 = Lawson ID"}]},{"description":"SCREW P/T 5.0X60MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055381","type":"LOCAL"},{"code":"877829","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055381 = Hospital System Supply Identifier | 877829 = Lawson ID"}]},{"description":"SCREW P/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055382","type":"LOCAL"},{"code":"877830","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055382 = Hospital System Supply Identifier | 877830 = Lawson ID"}]},{"description":"SCREW P/T 5.0X65MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055383","type":"LOCAL"},{"code":"877831","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055383 = Hospital System Supply Identifier | 877831 = Lawson ID"}]},{"description":"SCREW P/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055384","type":"LOCAL"},{"code":"877832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055384 = Hospital System Supply Identifier | 877832 = Lawson ID"}]},{"description":"SCREW P/T 5.0X70MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055385","type":"LOCAL"},{"code":"877833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055385 = Hospital System Supply Identifier | 877833 = Lawson ID"}]},{"description":"SCREW P/T 5.0X75MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055386","type":"LOCAL"},{"code":"877834","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055386 = Hospital System Supply Identifier | 877834 = Lawson ID"}]},{"description":"SCREW P/T 5.0X80MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055387","type":"LOCAL"},{"code":"877835","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055387 = Hospital System Supply Identifier | 877835 = Lawson ID"}]},{"description":"SCREW P/T 5.0X85MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055388","type":"LOCAL"},{"code":"877836","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055388 = Hospital System Supply Identifier | 877836 = Lawson ID"}]},{"description":"SCREW P/T 5.0X95MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055390","type":"LOCAL"},{"code":"877838","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055390 = Hospital System Supply Identifier | 877838 = Lawson ID"}]},{"description":"SCREW P/T 5.0X90MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055389","type":"LOCAL"},{"code":"877837","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055389 = Hospital System Supply Identifier | 877837 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356756","type":"LOCAL"},{"code":"1083665","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356756 = Hospital System Supply Identifier | 1083665 = Lawson ID"}]},{"description":"SCREW P/T 5.0X100MM","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055391","type":"LOCAL"},{"code":"877839","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1055391 = Hospital System Supply Identifier | 877839 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356851","type":"LOCAL"},{"code":"1083622","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356851 = Hospital System Supply Identifier | 1083622 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357072","type":"LOCAL"},{"code":"1083725","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357072 = Hospital System Supply Identifier | 1083725 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356388","type":"LOCAL"},{"code":"1083687","type":"LOCAL"}],"standard_charges":[{"gross_charge":1339.5,"discounted_cash":1004.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356388 = Hospital System Supply Identifier | 1083687 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356362","type":"LOCAL"},{"code":"1083633","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356362 = Hospital System Supply Identifier | 1083633 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356365","type":"LOCAL"},{"code":"1083695","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356365 = Hospital System Supply Identifier | 1083695 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357237","type":"LOCAL"},{"code":"1083681","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357237 = Hospital System Supply Identifier | 1083681 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356860","type":"LOCAL"},{"code":"1083671","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356860 = Hospital System Supply Identifier | 1083671 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356842","type":"LOCAL"},{"code":"1083632","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356842 = Hospital System Supply Identifier | 1083632 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356750","type":"LOCAL"},{"code":"1083626","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356750 = Hospital System Supply Identifier | 1083626 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357257","type":"LOCAL"},{"code":"1083551","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357257 = Hospital System Supply Identifier | 1083551 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356991","type":"LOCAL"},{"code":"1083590","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356991 = Hospital System Supply Identifier | 1083590 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356843","type":"LOCAL"},{"code":"1083698","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356843 = Hospital System Supply Identifier | 1083698 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356600","type":"LOCAL"},{"code":"1083703","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356600 = Hospital System Supply Identifier | 1083703 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357119","type":"LOCAL"},{"code":"1083568","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357119 = Hospital System Supply Identifier | 1083568 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356381","type":"LOCAL"},{"code":"1083605","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356381 = Hospital System Supply Identifier | 1083605 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356760","type":"LOCAL"},{"code":"1083614","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356760 = Hospital System Supply Identifier | 1083614 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356757","type":"LOCAL"},{"code":"1083672","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356757 = Hospital System Supply Identifier | 1083672 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356836","type":"LOCAL"},{"code":"1083697","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356836 = Hospital System Supply Identifier | 1083697 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356975","type":"LOCAL"},{"code":"1083623","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356975 = Hospital System Supply Identifier | 1083623 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356752","type":"LOCAL"},{"code":"1083542","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356752 = Hospital System Supply Identifier | 1083542 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357123","type":"LOCAL"},{"code":"1083618","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357123 = Hospital System Supply Identifier | 1083618 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356717","type":"LOCAL"},{"code":"1083651","type":"LOCAL"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":583.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356717 = Hospital System Supply Identifier | 1083651 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107240 TITANIUM 7X240MM","code_information":[{"code":"Sx00-1510-724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356373","type":"LOCAL"},{"code":"1082473","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356373 = Hospital System Supply Identifier | 1082473 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107255 TITANIUM 7X255MM","code_information":[{"code":"Sx00-1510-725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356867","type":"LOCAL"},{"code":"1082526","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356867 = Hospital System Supply Identifier | 1082526 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107270 TITANIUM 7X270MM","code_information":[{"code":"Sx00-1510-727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357210","type":"LOCAL"},{"code":"1082546","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357210 = Hospital System Supply Identifier | 1082546 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107285 TITANIUM 7X285MM","code_information":[{"code":"Sx00-1510-728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356728","type":"LOCAL"},{"code":"1082429","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356728 = Hospital System Supply Identifier | 1082429 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107300 TITANIUM 7X300MM","code_information":[{"code":"Sx00-1510-730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356706","type":"LOCAL"},{"code":"1082511","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356706 = Hospital System Supply Identifier | 1082511 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107315 TITANIUM 7X315MM","code_information":[{"code":"Sx00-1510-731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356742","type":"LOCAL"},{"code":"1082580","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356742 = Hospital System Supply Identifier | 1082580 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107330 TITANIUM 7X330MM","code_information":[{"code":"Sx00-1510-733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357052","type":"LOCAL"},{"code":"1082569","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357052 = Hospital System Supply Identifier | 1082569 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107345 TITANIUM 7X345MM","code_information":[{"code":"Sx00-1510-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356554","type":"LOCAL"},{"code":"1082439","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356554 = Hospital System Supply Identifier | 1082439 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107360 TITANIUM 7X360MM","code_information":[{"code":"Sx00-1510-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356614","type":"LOCAL"},{"code":"1082475","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356614 = Hospital System Supply Identifier | 1082475 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107375 TITANIUM 7X375MM","code_information":[{"code":"Sx00-1510-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357250","type":"LOCAL"},{"code":"1082549","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357250 = Hospital System Supply Identifier | 1082549 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107390 TITANIUM 7X390MM","code_information":[{"code":"Sx00-1510-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356831","type":"LOCAL"},{"code":"1082568","type":"LOCAL"}],"standard_charges":[{"gross_charge":11240.62,"discounted_cash":8430.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356831 = Hospital System Supply Identifier | 1082568 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108240 TITANIUM 8X240MM","code_information":[{"code":"Sx00-1510-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356494","type":"LOCAL"},{"code":"1082451","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356494 = Hospital System Supply Identifier | 1082451 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108255 TITANIUM 8X255MM","code_information":[{"code":"Sx00-1510-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357220","type":"LOCAL"},{"code":"1082593","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357220 = Hospital System Supply Identifier | 1082593 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108270 TITANIUM 8X270MM","code_information":[{"code":"Sx00-1510-827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356368","type":"LOCAL"},{"code":"1082490","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356368 = Hospital System Supply Identifier | 1082490 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108285 TITANIUM 8X285MM","code_information":[{"code":"Sx00-1510-828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356512","type":"LOCAL"},{"code":"1082436","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356512 = Hospital System Supply Identifier | 1082436 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108300 TITANIUM 8X300MM","code_information":[{"code":"Sx00-1510-830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356825","type":"LOCAL"},{"code":"1082563","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356825 = Hospital System Supply Identifier | 1082563 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108315 TITANIUM 8X315MM","code_information":[{"code":"Sx00-1510-831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356859","type":"LOCAL"},{"code":"1082427","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356859 = Hospital System Supply Identifier | 1082427 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108330 TITANIUM 8X330MM","code_information":[{"code":"Sx00-1510-833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357075","type":"LOCAL"},{"code":"1082591","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357075 = Hospital System Supply Identifier | 1082591 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108345 TITANIUM 8X345MM","code_information":[{"code":"Sx00-1510-834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356604","type":"LOCAL"},{"code":"1082437","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356604 = Hospital System Supply Identifier | 1082437 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108360 TITANIUM 8X360MM","code_information":[{"code":"Sx00-1510-836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357195","type":"LOCAL"},{"code":"1082542","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357195 = Hospital System Supply Identifier | 1082542 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108375 TITANIUM 8X375MM","code_information":[{"code":"Sx00-1510-837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356692","type":"LOCAL"},{"code":"1082586","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356692 = Hospital System Supply Identifier | 1082586 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108390 TITANIUM 8X390MM","code_information":[{"code":"Sx00-1510-839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357034","type":"LOCAL"},{"code":"1082525","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357034 = Hospital System Supply Identifier | 1082525 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108405 TITANIUM 8X405MM","code_information":[{"code":"Sx00-1510-840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356739","type":"LOCAL"},{"code":"1082470","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356739 = Hospital System Supply Identifier | 1082470 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108420 TITANIUM 8X420MM","code_information":[{"code":"Sx00-1510-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356475","type":"LOCAL"},{"code":"1082518","type":"LOCAL"}],"standard_charges":[{"gross_charge":11496.09,"discounted_cash":8622.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356475 = Hospital System Supply Identifier | 1082518 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109240 TITANIUM 9X240MM","code_information":[{"code":"Sx00-1510-924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356910","type":"LOCAL"},{"code":"1082484","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356910 = Hospital System Supply Identifier | 1082484 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109255 TITANIUM 9X255MM","code_information":[{"code":"Sx00-1510-925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356511","type":"LOCAL"},{"code":"1082499","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356511 = Hospital System Supply Identifier | 1082499 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109270 TITANIUM 9X270MM","code_information":[{"code":"Sx00-1510-927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356727","type":"LOCAL"},{"code":"1082433","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356727 = Hospital System Supply Identifier | 1082433 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109285 TITANIUM 9X285MM","code_information":[{"code":"Sx00-1510-928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356705","type":"LOCAL"},{"code":"1082500","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356705 = Hospital System Supply Identifier | 1082500 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109300 TITANIUM 9X300MM","code_information":[{"code":"Sx00-1510-930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356389","type":"LOCAL"},{"code":"1082541","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356389 = Hospital System Supply Identifier | 1082541 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109315 TITANIUM 9X315MM","code_information":[{"code":"Sx00-1510-931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356830","type":"LOCAL"},{"code":"1082522","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356830 = Hospital System Supply Identifier | 1082522 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109330 TITANIUM 9X330MM","code_information":[{"code":"Sx00-1510-933","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357134","type":"LOCAL"},{"code":"1082537","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357134 = Hospital System Supply Identifier | 1082537 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109345 TITANIUM 9X345MM","code_information":[{"code":"Sx00-1510-934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356490","type":"LOCAL"},{"code":"1082506","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356490 = Hospital System Supply Identifier | 1082506 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109360 TITANIUM 9X360MM","code_information":[{"code":"Sx00-1510-936","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356476","type":"LOCAL"},{"code":"1082551","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356476 = Hospital System Supply Identifier | 1082551 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109375 TITANIUM 9X375MM","code_information":[{"code":"Sx00-1510-937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356845","type":"LOCAL"},{"code":"1082527","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356845 = Hospital System Supply Identifier | 1082527 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109390 TITANIUM 9X390MM","code_information":[{"code":"Sx00-1510-939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356491","type":"LOCAL"},{"code":"1082466","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356491 = Hospital System Supply Identifier | 1082466 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109405 TITANIUM 9X405MM","code_information":[{"code":"Sx00-1510-940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356735","type":"LOCAL"},{"code":"1082493","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356735 = Hospital System Supply Identifier | 1082493 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109420 TITANIUM 9X420MM","code_information":[{"code":"Sx00-1510-942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356489","type":"LOCAL"},{"code":"1082447","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356489 = Hospital System Supply Identifier | 1082447 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110270 TITANIUM 10X270MM","code_information":[{"code":"Sx00-1511-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357174","type":"LOCAL"},{"code":"1082440","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357174 = Hospital System Supply Identifier | 1082440 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110285 TITANIUM 10X285MM","code_information":[{"code":"Sx00-1511-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356768","type":"LOCAL"},{"code":"1082479","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356768 = Hospital System Supply Identifier | 1082479 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110300 TITANIUM 10X300MM","code_information":[{"code":"Sx00-1511-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356978","type":"LOCAL"},{"code":"1082552","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356978 = Hospital System Supply Identifier | 1082552 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110315 TITANIUM 10X315MM","code_information":[{"code":"Sx00-1511-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357110","type":"LOCAL"},{"code":"1082471","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357110 = Hospital System Supply Identifier | 1082471 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110330 TITANIUM 10X330MM","code_information":[{"code":"Sx00-1511-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356616","type":"LOCAL"},{"code":"1082458","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356616 = Hospital System Supply Identifier | 1082458 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110345 TITANIUM 10X345MM","code_information":[{"code":"Sx00-1511-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356357","type":"LOCAL"},{"code":"1082516","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356357 = Hospital System Supply Identifier | 1082516 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110360 TITANIUM 10X360MM","code_information":[{"code":"Sx00-1511-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357177","type":"LOCAL"},{"code":"1082528","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357177 = Hospital System Supply Identifier | 1082528 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110375 TITANIUM 10X375MM","code_information":[{"code":"Sx00-1511-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356320","type":"LOCAL"},{"code":"1082469","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356320 = Hospital System Supply Identifier | 1082469 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110390 TITANIUM 10X390MM","code_information":[{"code":"Sx00-1511-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357227","type":"LOCAL"},{"code":"1082598","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357227 = Hospital System Supply Identifier | 1082598 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110405 TITANIUM 10X405MM","code_information":[{"code":"Sx00-1511-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356673","type":"LOCAL"},{"code":"1082524","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356673 = Hospital System Supply Identifier | 1082524 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110420 TITANIUM 10X420MM","code_information":[{"code":"Sx00-1511-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356959","type":"LOCAL"},{"code":"1082489","type":"LOCAL"}],"standard_charges":[{"gross_charge":11763.42,"discounted_cash":8822.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356959 = Hospital System Supply Identifier | 1082489 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111270 TITANIUM 11X270MM","code_information":[{"code":"Sx00-1511-127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356800","type":"LOCAL"},{"code":"1082446","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356800 = Hospital System Supply Identifier | 1082446 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111285 TITANIUM 11X285MM","code_information":[{"code":"Sx00-1511-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357032","type":"LOCAL"},{"code":"1082498","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357032 = Hospital System Supply Identifier | 1082498 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111300 TITANIUM 11X300MM","code_information":[{"code":"Sx00-1511-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356583","type":"LOCAL"},{"code":"1082503","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356583 = Hospital System Supply Identifier | 1082503 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111315 TITANIUM 11X315MM","code_information":[{"code":"Sx00-1511-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356941","type":"LOCAL"},{"code":"1082501","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356941 = Hospital System Supply Identifier | 1082501 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111330 TITANIUM 11X330MM","code_information":[{"code":"Sx00-1511-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357249","type":"LOCAL"},{"code":"1082538","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357249 = Hospital System Supply Identifier | 1082538 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111345 TITANIUM 11X345MM","code_information":[{"code":"Sx00-1511-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356429","type":"LOCAL"},{"code":"1082508","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356429 = Hospital System Supply Identifier | 1082508 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111360 TITANIUM 11X360MM","code_information":[{"code":"Sx00-1511-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357096","type":"LOCAL"},{"code":"1082515","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357096 = Hospital System Supply Identifier | 1082515 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111375 TITANIUM 11X375MM","code_information":[{"code":"Sx00-1511-137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357138","type":"LOCAL"},{"code":"1082557","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357138 = Hospital System Supply Identifier | 1082557 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111390 TITANIUM 11X390MM","code_information":[{"code":"Sx00-1511-139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356605","type":"LOCAL"},{"code":"1082488","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356605 = Hospital System Supply Identifier | 1082488 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111405 TITANIUM 11X405MM","code_information":[{"code":"Sx00-1511-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356732","type":"LOCAL"},{"code":"1082472","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356732 = Hospital System Supply Identifier | 1082472 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111420 TITANIUM 11X420MM","code_information":[{"code":"Sx00-1511-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356346","type":"LOCAL"},{"code":"1082544","type":"LOCAL"}],"standard_charges":[{"gross_charge":12043.5,"discounted_cash":9032.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356346 = Hospital System Supply Identifier | 1082544 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112285 TITANIUM 12X285MM","code_information":[{"code":"Sx00-1511-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356319","type":"LOCAL"},{"code":"1082462","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356319 = Hospital System Supply Identifier | 1082462 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112300 TITANIUM 12X300MM","code_information":[{"code":"Sx00-1511-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357256","type":"LOCAL"},{"code":"1082567","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357256 = Hospital System Supply Identifier | 1082567 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112315 TITANIUM 12X315MM","code_information":[{"code":"Sx00-1511-231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357178","type":"LOCAL"},{"code":"1082520","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357178 = Hospital System Supply Identifier | 1082520 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112330 TITANIUM 12X330MM","code_information":[{"code":"Sx00-1511-233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356738","type":"LOCAL"},{"code":"1082452","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356738 = Hospital System Supply Identifier | 1082452 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112345 TITANIUM 12X345MM","code_information":[{"code":"Sx00-1511-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356671","type":"LOCAL"},{"code":"1082434","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356671 = Hospital System Supply Identifier | 1082434 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112360 TITANIUM 12X360MM","code_information":[{"code":"Sx00-1511-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357079","type":"LOCAL"},{"code":"1082533","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357079 = Hospital System Supply Identifier | 1082533 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112375 TITANIUM 12X375MM","code_information":[{"code":"Sx00-1511-237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356556","type":"LOCAL"},{"code":"1082512","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356556 = Hospital System Supply Identifier | 1082512 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112390 TITANIUM 12X390MM","code_information":[{"code":"Sx00-1511-239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356814","type":"LOCAL"},{"code":"1082596","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356814 = Hospital System Supply Identifier | 1082596 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112405 TITANIUM 12X405MM","code_information":[{"code":"Sx00-1511-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356801","type":"LOCAL"},{"code":"1082459","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356801 = Hospital System Supply Identifier | 1082459 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112420 TITANIUM 12X420MM","code_information":[{"code":"Sx00-1511-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356595","type":"LOCAL"},{"code":"1082564","type":"LOCAL"}],"standard_charges":[{"gross_charge":12337.25,"discounted_cash":9252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356595 = Hospital System Supply Identifier | 1082564 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240020 4.0X20MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357240","type":"LOCAL"},{"code":"1082497","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357240 = Hospital System Supply Identifier | 1082497 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240025 4.0X25MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356866","type":"LOCAL"},{"code":"1082467","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356866 = Hospital System Supply Identifier | 1082467 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240035 4.0X35MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356321","type":"LOCAL"},{"code":"1082519","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356321 = Hospital System Supply Identifier | 1082519 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240030 4.0X30MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356922","type":"LOCAL"},{"code":"1082558","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356922 = Hospital System Supply Identifier | 1082558 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240040 4.0X40MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357106","type":"LOCAL"},{"code":"1082455","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357106 = Hospital System Supply Identifier | 1082455 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240045 4.0X45MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357214","type":"LOCAL"},{"code":"1082565","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357214 = Hospital System Supply Identifier | 1082565 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240055 4.0X55MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356833","type":"LOCAL"},{"code":"1082444","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356833 = Hospital System Supply Identifier | 1082444 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240050 4.0X50MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357054","type":"LOCAL"},{"code":"1082583","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357054 = Hospital System Supply Identifier | 1082583 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240060 4.0X60MM","code_information":[{"code":"Sx00-1524-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356688","type":"LOCAL"},{"code":"1082539","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356688 = Hospital System Supply Identifier | 1082539 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240175 4.0X17.5MM","code_information":[{"code":"Sx00-1524-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357176","type":"LOCAL"},{"code":"1082514","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357176 = Hospital System Supply Identifier | 1082514 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240225 4.0X22.5MM","code_information":[{"code":"Sx00-1524-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356994","type":"LOCAL"},{"code":"1082578","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356994 = Hospital System Supply Identifier | 1082578 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240275 4.0X27.5MM","code_information":[{"code":"Sx00-1524-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356710","type":"LOCAL"},{"code":"1082465","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356710 = Hospital System Supply Identifier | 1082465 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240325 4.0X32.5MM","code_information":[{"code":"Sx00-1524-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357248","type":"LOCAL"},{"code":"1082494","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357248 = Hospital System Supply Identifier | 1082494 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240375 4.0X37.5MM","code_information":[{"code":"Sx00-1524-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356924","type":"LOCAL"},{"code":"1082573","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356924 = Hospital System Supply Identifier | 1082573 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240425 4.0X42.5MM","code_information":[{"code":"Sx00-1524-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356943","type":"LOCAL"},{"code":"1082529","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356943 = Hospital System Supply Identifier | 1082529 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240475 4.0X47.5MM","code_information":[{"code":"Sx00-1524-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357175","type":"LOCAL"},{"code":"1082442","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357175 = Hospital System Supply Identifier | 1082442 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240525 4.0X52.5MM","code_information":[{"code":"Sx00-1524-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356803","type":"LOCAL"},{"code":"1082478","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356803 = Hospital System Supply Identifier | 1082478 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240575 4.0X57.5MM","code_information":[{"code":"Sx00-1524-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357030","type":"LOCAL"},{"code":"1082477","type":"LOCAL"}],"standard_charges":[{"gross_charge":907.49,"discounted_cash":680.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357030 = Hospital System Supply Identifier | 1082477 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245020 4.5X20MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356733","type":"LOCAL"},{"code":"1082495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356733 = Hospital System Supply Identifier | 1082495 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245025 4.5X25MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356572","type":"LOCAL"},{"code":"1082561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356572 = Hospital System Supply Identifier | 1082561 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245035 4.5X35MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357089","type":"LOCAL"},{"code":"1082531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357089 = Hospital System Supply Identifier | 1082531 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245030 4.5X30MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357055","type":"LOCAL"},{"code":"1082590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357055 = Hospital System Supply Identifier | 1082590 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245045 4.5X45MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356465","type":"LOCAL"},{"code":"1082523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356465 = Hospital System Supply Identifier | 1082523 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245040 4.5X40MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357031","type":"LOCAL"},{"code":"1082481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357031 = Hospital System Supply Identifier | 1082481 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245050 4.5X50MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357261","type":"LOCAL"},{"code":"1082468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357261 = Hospital System Supply Identifier | 1082468 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245055 4.5X55MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357082","type":"LOCAL"},{"code":"1082582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357082 = Hospital System Supply Identifier | 1082582 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245065 4.5X65MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356586","type":"LOCAL"},{"code":"1082553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356586 = Hospital System Supply Identifier | 1082553 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245060 4.5X60MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356832","type":"LOCAL"},{"code":"1082585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356832 = Hospital System Supply Identifier | 1082585 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245070 4.5X70MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356371","type":"LOCAL"},{"code":"1082461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356371 = Hospital System Supply Identifier | 1082461 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245075 4.5X75MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356573","type":"LOCAL"},{"code":"1082587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356573 = Hospital System Supply Identifier | 1082587 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245080 4.5X80MM","code_information":[{"code":"Sx00-1524-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357137","type":"LOCAL"},{"code":"1082482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357137 = Hospital System Supply Identifier | 1082482 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245175 4.5X17.5MM","code_information":[{"code":"Sx00-1524-517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357053","type":"LOCAL"},{"code":"1082576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357053 = Hospital System Supply Identifier | 1082576 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245225 4.5X22.5MM","code_information":[{"code":"Sx00-1524-522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356372","type":"LOCAL"},{"code":"1082487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356372 = Hospital System Supply Identifier | 1082487 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245275 4.5X27.5MM","code_information":[{"code":"Sx00-1524-527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356426","type":"LOCAL"},{"code":"1082453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356426 = Hospital System Supply Identifier | 1082453 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245325 4.5X32.5MM","code_information":[{"code":"Sx00-1524-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356383","type":"LOCAL"},{"code":"1082575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356383 = Hospital System Supply Identifier | 1082575 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245375 4.5X37.5MM","code_information":[{"code":"Sx00-1524-537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356690","type":"LOCAL"},{"code":"1082570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356690 = Hospital System Supply Identifier | 1082570 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245425 4.5X42.5MM","code_information":[{"code":"Sx00-1524-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356691","type":"LOCAL"},{"code":"1082577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356691 = Hospital System Supply Identifier | 1082577 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245475 4.5X47.5MM","code_information":[{"code":"Sx00-1524-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357244","type":"LOCAL"},{"code":"1082450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357244 = Hospital System Supply Identifier | 1082450 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245525 4.5X52.5MM","code_information":[{"code":"Sx00-1524-552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356865","type":"LOCAL"},{"code":"1082510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356865 = Hospital System Supply Identifier | 1082510 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245575 4.5X57.5MM","code_information":[{"code":"Sx00-1524-557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356945","type":"LOCAL"},{"code":"1082592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356945 = Hospital System Supply Identifier | 1082592 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245625 4.5X62.5MM","code_information":[{"code":"Sx00-1524-562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356829","type":"LOCAL"},{"code":"1082502","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356829 = Hospital System Supply Identifier | 1082502 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245675 4.5X67.5MM","code_information":[{"code":"Sx00-1524-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357125","type":"LOCAL"},{"code":"1082594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357125 = Hospital System Supply Identifier | 1082594 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245725 4.5X72.5MM","code_information":[{"code":"Sx00-1524-572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357081","type":"LOCAL"},{"code":"1082562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357081 = Hospital System Supply Identifier | 1082562 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245775 4.5X77.5MM","code_information":[{"code":"Sx00-1524-577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357196","type":"LOCAL"},{"code":"1082589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1166.6,"discounted_cash":874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357196 = Hospital System Supply Identifier | 1082589 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250020 5.0X20MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357270","type":"LOCAL"},{"code":"1082454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357270 = Hospital System Supply Identifier | 1082454 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250025 5.0X25MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356349","type":"LOCAL"},{"code":"1082463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356349 = Hospital System Supply Identifier | 1082463 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250030 5.0X30MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356961","type":"LOCAL"},{"code":"1082492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356961 = Hospital System Supply Identifier | 1082492 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250035 5.0X35MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356585","type":"LOCAL"},{"code":"1082548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356585 = Hospital System Supply Identifier | 1082548 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250045 5.0X45MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357107","type":"LOCAL"},{"code":"1082491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357107 = Hospital System Supply Identifier | 1082491 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250040 5.0X40MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356347","type":"LOCAL"},{"code":"1082584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356347 = Hospital System Supply Identifier | 1082584 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250055 5.0X55MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356958","type":"LOCAL"},{"code":"1082438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356958 = Hospital System Supply Identifier | 1082438 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250050 5.0X50MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357215","type":"LOCAL"},{"code":"1082579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357215 = Hospital System Supply Identifier | 1082579 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250065 5.0X65MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356923","type":"LOCAL"},{"code":"1082588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356923 = Hospital System Supply Identifier | 1082588 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250060 5.0X60MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356864","type":"LOCAL"},{"code":"1082435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356864 = Hospital System Supply Identifier | 1082435 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250075 5.0X75MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356902","type":"LOCAL"},{"code":"1082758","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356902 = Hospital System Supply Identifier | 1082758 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250070 5.0X70MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356424","type":"LOCAL"},{"code":"1082818","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356424 = Hospital System Supply Identifier | 1082818 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250080 5.0X80MM","code_information":[{"code":"Sx00-1525-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356443","type":"LOCAL"},{"code":"1082669","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356443 = Hospital System Supply Identifier | 1082669 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250175 5.0X17.5MM","code_information":[{"code":"Sx00-1525-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357170","type":"LOCAL"},{"code":"1082730","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357170 = Hospital System Supply Identifier | 1082730 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250225 5.0X22.5MM","code_information":[{"code":"Sx00-1525-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356380","type":"LOCAL"},{"code":"1082805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356380 = Hospital System Supply Identifier | 1082805 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250275 5.0X27.5MM","code_information":[{"code":"Sx00-1525-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356783","type":"LOCAL"},{"code":"1082831","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356783 = Hospital System Supply Identifier | 1082831 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250325 5.0X32.5MM","code_information":[{"code":"Sx00-1525-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356314","type":"LOCAL"},{"code":"1082854","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356314 = Hospital System Supply Identifier | 1082854 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250375 5.0X37.5MM","code_information":[{"code":"Sx00-1525-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357207","type":"LOCAL"},{"code":"1082635","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357207 = Hospital System Supply Identifier | 1082635 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250425 5.0X42.5MM","code_information":[{"code":"Sx00-1525-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356575","type":"LOCAL"},{"code":"1082632","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356575 = Hospital System Supply Identifier | 1082632 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250475 5.0X47.5MM","code_information":[{"code":"Sx00-1525-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356920","type":"LOCAL"},{"code":"1082620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356920 = Hospital System Supply Identifier | 1082620 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250525 5.0X52.5MM","code_information":[{"code":"Sx00-1525-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357201","type":"LOCAL"},{"code":"1082697","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357201 = Hospital System Supply Identifier | 1082697 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250575 5.0X57.5MM","code_information":[{"code":"Sx00-1525-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356669","type":"LOCAL"},{"code":"1082728","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356669 = Hospital System Supply Identifier | 1082728 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250625 5.0X62.5MM","code_information":[{"code":"Sx00-1525-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357064","type":"LOCAL"},{"code":"1082651","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357064 = Hospital System Supply Identifier | 1082651 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250675 5.0X67.5MM","code_information":[{"code":"Sx00-1525-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357226","type":"LOCAL"},{"code":"1082832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357226 = Hospital System Supply Identifier | 1082832 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250725 5.0X72.5MM","code_information":[{"code":"Sx00-1525-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356818","type":"LOCAL"},{"code":"1082699","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356818 = Hospital System Supply Identifier | 1082699 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250775 5.0X77.5MM","code_information":[{"code":"Sx00-1525-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357044","type":"LOCAL"},{"code":"1082653","type":"LOCAL"}],"standard_charges":[{"gross_charge":1342.32,"discounted_cash":1006.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357044 = Hospital System Supply Identifier | 1082653 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL FLUSH PNP TIBIA 0015300000","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356550","type":"LOCAL"},{"code":"1082637","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356550 = Hospital System Supply Identifier | 1082637 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300005 9.75X5MM","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356306","type":"LOCAL"},{"code":"1082721","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356306 = Hospital System Supply Identifier | 1082721 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300010 9.75X10MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357208","type":"LOCAL"},{"code":"1082808","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357208 = Hospital System Supply Identifier | 1082808 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300015 9.75X15MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356442","type":"LOCAL"},{"code":"1082627","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356442 = Hospital System Supply Identifier | 1082627 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301005 10.5X5MM","code_information":[{"code":"Sx00-1530-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356893","type":"LOCAL"},{"code":"1082816","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356893 = Hospital System Supply Identifier | 1082816 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301010 10.5X10MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356652","type":"LOCAL"},{"code":"1082701","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356652 = Hospital System Supply Identifier | 1082701 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301015 10.5X15MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356529","type":"LOCAL"},{"code":"1082710","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356529 = Hospital System Supply Identifier | 1082710 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301105 11X5MM","code_information":[{"code":"Sx00-1530-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356782","type":"LOCAL"},{"code":"1082822","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356782 = Hospital System Supply Identifier | 1082822 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301115 11X15MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356653","type":"LOCAL"},{"code":"1082706","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356653 = Hospital System Supply Identifier | 1082706 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301110 11X10MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356956","type":"LOCAL"},{"code":"1082843","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356956 = Hospital System Supply Identifier | 1082843 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301205 12X5MM","code_information":[{"code":"Sx00-1530-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357114","type":"LOCAL"},{"code":"1082631","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357114 = Hospital System Supply Identifier | 1082631 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301215 12X15MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357004","type":"LOCAL"},{"code":"1082844","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1357004 = Hospital System Supply Identifier | 1082844 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301210 12X10MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356553","type":"LOCAL"},{"code":"1082693","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.09,"discounted_cash":685.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1356553 = Hospital System Supply Identifier | 1082693 = Lawson ID"}]},{"description":"DISC - COLLAR CERV PHILA 2P MED 4.25","code_information":[{"code":"Sx00-1741-011","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"836004","type":"LOCAL"},{"code":"106761","type":"LOCAL"}],"standard_charges":[{"gross_charge":73.36,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 836004 = Hospital System Supply Identifier | 106761 = Lawson ID"}]},{"description":"REAMER FLEX IM 12.5MM DIA","code_information":[{"code":"Sx00-2228-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"411217","type":"LOCAL"},{"code":"459165","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411217 = Hospital System Supply Identifier | 459165 = Lawson ID"}]},{"description":"REAMER FLEX IM 13MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"411218","type":"LOCAL"},{"code":"459166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411218 = Hospital System Supply Identifier | 459166 = Lawson ID"}]},{"description":"REAMER FLEX IM 13.5MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"411219","type":"LOCAL"},{"code":"459167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411219 = Hospital System Supply Identifier | 459167 = Lawson ID"}]},{"description":"REAMER FLEX IM 14MM DIA","code_information":[{"code":"Sx00-2228-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"411220","type":"LOCAL"},{"code":"459168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1297.2,"discounted_cash":972.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411220 = Hospital System Supply Identifier | 459168 = Lawson ID"}]},{"description":"REAMER SURGICAL 24MM FLEXIBLE","code_information":[{"code":"Sx00-2228-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"35478","type":"LOCAL"},{"code":"158616","type":"LOCAL"}],"standard_charges":[{"gross_charge":278.35,"discounted_cash":208.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 35478 = Hospital System Supply Identifier | 158616 = Lawson ID"}]},{"description":"INST CABLE-READY SET","code_information":[{"code":"Sx00-2232-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"202248","type":"LOCAL"},{"code":"452346","type":"LOCAL"}],"standard_charges":[{"gross_charge":17071.6,"discounted_cash":12803.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 202248 = Hospital System Supply Identifier | 452346 = Lawson ID"}]},{"description":"BUTTON HEX 2.5MM 2232-01-25","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408802","type":"LOCAL"},{"code":"339930","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408802 = Hospital System Supply Identifier | 339930 = Lawson ID"}]},{"description":"BUTTON HEX SS 5.0MM","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410423","type":"LOCAL"},{"code":"416866","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.8,"discounted_cash":131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 410423 = Hospital System Supply Identifier | 416866 = Lawson ID"}]},{"description":"CBL DEV GTR LNG W/O CBL","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"17233","type":"LOCAL"},{"code":"144555","type":"LOCAL"}],"standard_charges":[{"gross_charge":4153.8,"discounted_cash":3115.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 17233 = Hospital System Supply Identifier | 144555 = Lawson ID"}]},{"description":"BUTTON BONE GRIP CABLE READY 00223200225 TITANIUM 2.5MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1161459","type":"LOCAL"},{"code":"1002959","type":"LOCAL"}],"standard_charges":[{"gross_charge":207.79,"discounted_cash":155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 1161459 = Hospital System Supply Identifier | 1002959 = Lawson ID"}]},{"description":"BUTTON HEX SNGL 5.0MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411310","type":"LOCAL"},{"code":"462060","type":"LOCAL"}],"standard_charges":[{"gross_charge":175.8,"discounted_cash":131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 411310 = Hospital System Supply Identifier | 462060 = Lawson ID"}]},{"description":"IMP CABLE SS 1.3 X 560MM","code_information":[{"code":"Sx00-2232-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408073","type":"LOCAL"},{"code":"245979","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.7,"discounted_cash":615.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 408073 = Hospital System Supply Identifier | 245979 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-21","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407866","type":"LOCAL"},{"code":"206454","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407866 = Hospital System Supply Identifier | 206454 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-18","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407865","type":"LOCAL"},{"code":"206453","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407865 = Hospital System Supply Identifier | 206453 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-20","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168183","type":"LOCAL"},{"code":"206449","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 168183 = Hospital System Supply Identifier | 206449 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-19","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407864","type":"LOCAL"},{"code":"206450","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.81,"discounted_cash":602.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407864 = Hospital System Supply Identifier | 206450 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X340MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407748","type":"LOCAL"},{"code":"205431","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407748 = Hospital System Supply Identifier | 205431 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X480MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407755","type":"LOCAL"},{"code":"205439","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407755 = Hospital System Supply Identifier | 205439 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X460MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407754","type":"LOCAL"},{"code":"205438","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407754 = Hospital System Supply Identifier | 205438 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X440MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407753","type":"LOCAL"},{"code":"205437","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407753 = Hospital System Supply Identifier | 205437 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X420MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407752","type":"LOCAL"},{"code":"205436","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407752 = Hospital System Supply Identifier | 205436 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X400MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407751","type":"LOCAL"},{"code":"205435","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407751 = Hospital System Supply Identifier | 205435 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X380MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407750","type":"LOCAL"},{"code":"205434","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407750 = Hospital System Supply Identifier | 205434 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X360MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407749","type":"LOCAL"},{"code":"205433","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407749 = Hospital System Supply Identifier | 205433 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X320MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407747","type":"LOCAL"},{"code":"205430","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407747 = Hospital System Supply Identifier | 205430 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X240MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407743","type":"LOCAL"},{"code":"205426","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407743 = Hospital System Supply Identifier | 205426 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X280MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407745","type":"LOCAL"},{"code":"205428","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407745 = Hospital System Supply Identifier | 205428 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X260MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407744","type":"LOCAL"},{"code":"205427","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407744 = Hospital System Supply Identifier | 205427 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X220MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407708","type":"LOCAL"},{"code":"205391","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407708 = Hospital System Supply Identifier | 205391 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X200MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407706","type":"LOCAL"},{"code":"205389","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407706 = Hospital System Supply Identifier | 205389 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X180MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407703","type":"LOCAL"},{"code":"205386","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407703 = Hospital System Supply Identifier | 205386 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X160MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407699","type":"LOCAL"},{"code":"205382","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407699 = Hospital System Supply Identifier | 205382 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X140MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407696","type":"LOCAL"},{"code":"205379","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407696 = Hospital System Supply Identifier | 205379 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X300MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407746","type":"LOCAL"},{"code":"205429","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407746 = Hospital System Supply Identifier | 205429 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X240MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407761","type":"LOCAL"},{"code":"205445","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407761 = Hospital System Supply Identifier | 205445 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X360MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407767","type":"LOCAL"},{"code":"205451","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407767 = Hospital System Supply Identifier | 205451 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X340MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407766","type":"LOCAL"},{"code":"205450","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407766 = Hospital System Supply Identifier | 205450 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X320MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407765","type":"LOCAL"},{"code":"205449","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407765 = Hospital System Supply Identifier | 205449 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X300MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407764","type":"LOCAL"},{"code":"205448","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407764 = Hospital System Supply Identifier | 205448 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X280MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407763","type":"LOCAL"},{"code":"205447","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407763 = Hospital System Supply Identifier | 205447 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X260MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407762","type":"LOCAL"},{"code":"205446","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407762 = Hospital System Supply Identifier | 205446 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X220MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407760","type":"LOCAL"},{"code":"205444","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407760 = Hospital System Supply Identifier | 205444 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X200MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407759","type":"LOCAL"},{"code":"205443","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407759 = Hospital System Supply Identifier | 205443 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X180MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407758","type":"LOCAL"},{"code":"205442","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407758 = Hospital System Supply Identifier | 205442 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X400MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407568","type":"LOCAL"},{"code":"205249","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407568 = Hospital System Supply Identifier | 205249 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X420MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407570","type":"LOCAL"},{"code":"205251","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407570 = Hospital System Supply Identifier | 205251 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X440MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407571","type":"LOCAL"},{"code":"205252","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407571 = Hospital System Supply Identifier | 205252 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X380MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407566","type":"LOCAL"},{"code":"205247","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407566 = Hospital System Supply Identifier | 205247 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X480MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407574","type":"LOCAL"},{"code":"205255","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407574 = Hospital System Supply Identifier | 205255 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X140MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407756","type":"LOCAL"},{"code":"205440","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407756 = Hospital System Supply Identifier | 205440 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X160MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407757","type":"LOCAL"},{"code":"205441","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407757 = Hospital System Supply Identifier | 205441 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X460MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407572","type":"LOCAL"},{"code":"205253","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407572 = Hospital System Supply Identifier | 205253 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X340MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407606","type":"LOCAL"},{"code":"205288","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407606 = Hospital System Supply Identifier | 205288 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X480MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407617","type":"LOCAL"},{"code":"205299","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407617 = Hospital System Supply Identifier | 205299 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X460MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407616","type":"LOCAL"},{"code":"205298","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407616 = Hospital System Supply Identifier | 205298 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X440MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407615","type":"LOCAL"},{"code":"205297","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407615 = Hospital System Supply Identifier | 205297 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X400MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407613","type":"LOCAL"},{"code":"205295","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407613 = Hospital System Supply Identifier | 205295 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X380MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407610","type":"LOCAL"},{"code":"205292","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407610 = Hospital System Supply Identifier | 205292 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X360MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407608","type":"LOCAL"},{"code":"205290","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407608 = Hospital System Supply Identifier | 205290 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X420MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407607","type":"LOCAL"},{"code":"205289","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407607 = Hospital System Supply Identifier | 205289 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X320MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407605","type":"LOCAL"},{"code":"205286","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407605 = Hospital System Supply Identifier | 205286 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X240MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407598","type":"LOCAL"},{"code":"205279","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407598 = Hospital System Supply Identifier | 205279 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X280MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407600","type":"LOCAL"},{"code":"205281","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407600 = Hospital System Supply Identifier | 205281 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X260MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407599","type":"LOCAL"},{"code":"205280","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407599 = Hospital System Supply Identifier | 205280 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X220MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407596","type":"LOCAL"},{"code":"205277","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407596 = Hospital System Supply Identifier | 205277 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X200MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407589","type":"LOCAL"},{"code":"205270","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407589 = Hospital System Supply Identifier | 205270 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X180MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407588","type":"LOCAL"},{"code":"205269","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407588 = Hospital System Supply Identifier | 205269 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X160MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407579","type":"LOCAL"},{"code":"205260","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407579 = Hospital System Supply Identifier | 205260 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X140MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407577","type":"LOCAL"},{"code":"205258","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407577 = Hospital System Supply Identifier | 205258 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X300MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407601","type":"LOCAL"},{"code":"205282","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407601 = Hospital System Supply Identifier | 205282 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X400MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407657","type":"LOCAL"},{"code":"205340","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407657 = Hospital System Supply Identifier | 205340 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X380MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407653","type":"LOCAL"},{"code":"205336","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407653 = Hospital System Supply Identifier | 205336 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X360MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407649","type":"LOCAL"},{"code":"205332","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407649 = Hospital System Supply Identifier | 205332 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X440MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407663","type":"LOCAL"},{"code":"205346","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407663 = Hospital System Supply Identifier | 205346 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X480MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407665","type":"LOCAL"},{"code":"205348","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407665 = Hospital System Supply Identifier | 205348 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X340MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407642","type":"LOCAL"},{"code":"205325","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407642 = Hospital System Supply Identifier | 205325 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X460MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407664","type":"LOCAL"},{"code":"205347","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407664 = Hospital System Supply Identifier | 205347 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X320MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407638","type":"LOCAL"},{"code":"205321","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407638 = Hospital System Supply Identifier | 205321 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X420MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407661","type":"LOCAL"},{"code":"205344","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407661 = Hospital System Supply Identifier | 205344 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X280MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407631","type":"LOCAL"},{"code":"205314","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407631 = Hospital System Supply Identifier | 205314 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X300MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407636","type":"LOCAL"},{"code":"205319","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407636 = Hospital System Supply Identifier | 205319 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X160MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407622","type":"LOCAL"},{"code":"205304","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407622 = Hospital System Supply Identifier | 205304 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X180MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407623","type":"LOCAL"},{"code":"205305","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407623 = Hospital System Supply Identifier | 205305 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X140MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407620","type":"LOCAL"},{"code":"205302","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407620 = Hospital System Supply Identifier | 205302 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X220MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407628","type":"LOCAL"},{"code":"205311","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407628 = Hospital System Supply Identifier | 205311 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X240MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407629","type":"LOCAL"},{"code":"205312","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407629 = Hospital System Supply Identifier | 205312 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X260MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407630","type":"LOCAL"},{"code":"205313","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407630 = Hospital System Supply Identifier | 205313 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X200MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407625","type":"LOCAL"},{"code":"205307","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407625 = Hospital System Supply Identifier | 205307 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X480MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407772","type":"LOCAL"},{"code":"205456","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407772 = Hospital System Supply Identifier | 205456 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X340MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407692","type":"LOCAL"},{"code":"205375","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407692 = Hospital System Supply Identifier | 205375 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X460MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407771","type":"LOCAL"},{"code":"205455","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407771 = Hospital System Supply Identifier | 205455 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X440MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407770","type":"LOCAL"},{"code":"205454","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407770 = Hospital System Supply Identifier | 205454 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X400MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407768","type":"LOCAL"},{"code":"205452","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407768 = Hospital System Supply Identifier | 205452 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X380MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407695","type":"LOCAL"},{"code":"205378","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407695 = Hospital System Supply Identifier | 205378 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X360MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407693","type":"LOCAL"},{"code":"205376","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407693 = Hospital System Supply Identifier | 205376 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X320MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407688","type":"LOCAL"},{"code":"205371","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407688 = Hospital System Supply Identifier | 205371 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X420MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407769","type":"LOCAL"},{"code":"205453","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407769 = Hospital System Supply Identifier | 205453 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X280MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407686","type":"LOCAL"},{"code":"205369","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407686 = Hospital System Supply Identifier | 205369 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X260MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407685","type":"LOCAL"},{"code":"205368","type":"LOCAL"}],"standard_charges":[{"gross_charge":2698.01,"discounted_cash":2023.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: OSS LOCATION | 407685 = Hospital System Supply Identifier | 205368 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X