{"hospital_name":"Methodist Hospital Levelland","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Covenant Hospital Levelland"],"hospital_address":["1900 College Ave, Levelland, TX 79336"],"license_information":{"license_number":"000307","state":"TX"},"type_2_npi":["1225146400","1154438588"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Cora Rivera"},"financial_aid_policy":["58% off of standard gross charges."],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Baylor Scott and White","plan_name":"Group BSW Plus All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Baylor Scott and White","plan_name":"Group BSW 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68-70","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326954","type":"LOCAL"},{"code":"408143","type":"LOCAL"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":803.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 326954 = Hospital System Supply Identifier | 408143 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 68MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303204","type":"LOCAL"},{"code":"522150","type":"LOCAL"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":803.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 303204 = Hospital System Supply Identifier | 522150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303207","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":803.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 303207 = Hospital System Supply Identifier | 522153 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 72","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326955","type":"LOCAL"},{"code":"408144","type":"LOCAL"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":803.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 326955 = Hospital System Supply Identifier | 408144 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 72MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303208","type":"LOCAL"},{"code":"522154","type":"LOCAL"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":803.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 303208 = Hospital System Supply Identifier | 522154 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X26MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303209","type":"LOCAL"},{"code":"522155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":803.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 303209 = Hospital System Supply Identifier | 522155 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 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20","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303642","type":"LOCAL"},{"code":"522599","type":"LOCAL"}],"standard_charges":[{"gross_charge":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 303642 = Hospital System Supply Identifier | 522599 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 14","code_information":[{"code":"Sx00-5976-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303640","type":"LOCAL"},{"code":"522597","type":"LOCAL"}],"standard_charges":[{"gross_charge":4050.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 303640 = Hospital System Supply Identifier | 522597 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC NXGN 1-2 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23MM","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198028","type":"LOCAL"},{"code":"443264","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 198028 = Hospital System Supply Identifier | 443264 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK CD1-2/12","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202243","type":"LOCAL"},{"code":"452341","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202243 = Hospital System Supply Identifier | 452341 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK CD1-2/17","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202244","type":"LOCAL"},{"code":"452342","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202244 = Hospital System Supply Identifier | 452342 = Lawson ID"}]},{"description":"IMP KNEE INS NXGN LOK CD1-2/20","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202245","type":"LOCAL"},{"code":"452343","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202245 = Hospital System Supply Identifier | 452343 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 1-2 10","code_information":[{"code":"Sx00-5994-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322047","type":"LOCAL"},{"code":"535261","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 322047 = Hospital System Supply Identifier | 535261 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 12","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322050","type":"LOCAL"},{"code":"535264","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 322050 = Hospital System Supply Identifier | 535264 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 23","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"322051","type":"LOCAL"},{"code":"535265","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 322051 = Hospital System Supply Identifier | 535265 = Lawson ID"}]},{"description":"IMP LCCK ART SURF CD 3-4 YE","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"317062","type":"LOCAL"},{"code":"446541","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 317062 = Hospital System Supply Identifier | 446541 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 17MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194029","type":"LOCAL"},{"code":"324227","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 194029 = Hospital System Supply Identifier | 324227 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329394","type":"LOCAL"},{"code":"324226","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 329394 = Hospital System Supply Identifier | 324226 = Lawson ID"}]},{"description":"IMP TIB INS POST NXGN SZ3-4 20","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"329395","type":"LOCAL"},{"code":"324228","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 329395 = Hospital System Supply Identifier | 324228 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5994-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"178421","type":"LOCAL"},{"code":"337485","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 178421 = Hospital System Supply Identifier | 337485 = Lawson ID"}]},{"description":"IMP TIB INS NXGN SZ3-4 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40X22","code_information":[{"code":"Sx00-6310-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304260","type":"LOCAL"},{"code":"523217","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304260 = Hospital System Supply Identifier | 523217 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-42-22","code_information":[{"code":"Sx00-6310-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328932","type":"LOCAL"},{"code":"204640","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 328932 = Hospital System Supply Identifier | 204640 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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6310-46-22","code_information":[{"code":"Sx00-6310-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328999","type":"LOCAL"},{"code":"208601","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 328999 = Hospital System Supply Identifier | 208601 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X46MM","code_information":[{"code":"Sx00-6310-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326726","type":"LOCAL"},{"code":"408167","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 326726 = Hospital System Supply Identifier | 408167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 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38X22","code_information":[{"code":"Sx00-6320-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304304","type":"LOCAL"},{"code":"523261","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304304 = Hospital System Supply Identifier | 523261 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 40X22","code_information":[{"code":"Sx00-6320-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304305","type":"LOCAL"},{"code":"523262","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304305 = Hospital System Supply Identifier | 523262 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 42X22","code_information":[{"code":"Sx00-6320-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304306","type":"LOCAL"},{"code":"523263","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304306 = Hospital System Supply Identifier | 523263 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 42X26","code_information":[{"code":"Sx00-6320-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304307","type":"LOCAL"},{"code":"523264","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304307 = Hospital System Supply Identifier | 523264 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 44X22","code_information":[{"code":"Sx00-6320-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304308","type":"LOCAL"},{"code":"523265","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304308 = Hospital System Supply Identifier | 523265 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 44X26","code_information":[{"code":"Sx00-6320-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304309","type":"LOCAL"},{"code":"523266","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304309 = Hospital System Supply Identifier | 523266 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 44X28","code_information":[{"code":"Sx00-6320-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304310","type":"LOCAL"},{"code":"523267","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304310 = Hospital System Supply Identifier | 523267 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 46X26","code_information":[{"code":"Sx00-6320-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304312","type":"LOCAL"},{"code":"523269","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304312 = Hospital System Supply Identifier | 523269 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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48X32","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304317","type":"LOCAL"},{"code":"523274","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304317 = Hospital System Supply Identifier | 523274 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 48X28","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304316","type":"LOCAL"},{"code":"523273","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304316 = Hospital System Supply Identifier | 523273 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 48X26","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304315","type":"LOCAL"},{"code":"523272","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304315 = Hospital System Supply Identifier | 523272 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 48X22","code_information":[{"code":"Sx00-6320-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304314","type":"LOCAL"},{"code":"523271","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304314 = Hospital System Supply Identifier | 523271 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY50/52/54","code_information":[{"code":"Sx00-6320-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"150025","type":"LOCAL"},{"code":"237682","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 150025 = Hospital System Supply Identifier | 237682 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 50X28","code_information":[{"code":"Sx00-6320-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"324848","type":"LOCAL"},{"code":"324312","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 324848 = Hospital System Supply Identifier | 324312 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 50-54X22","code_information":[{"code":"Sx00-6320-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304318","type":"LOCAL"},{"code":"523275","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304318 = Hospital System Supply Identifier | 523275 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 50-54X26","code_information":[{"code":"Sx00-6320-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304319","type":"LOCAL"},{"code":"523276","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 304319 = Hospital System Supply Identifier | 523276 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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62MM","code_information":[{"code":"Sx00-7053-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"95111","type":"LOCAL"},{"code":"310991","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 95111 = Hospital System Supply Identifier | 310991 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"192040","type":"LOCAL"},{"code":"210146","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 192040 = Hospital System Supply Identifier | 210146 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"192041","type":"LOCAL"},{"code":"210147","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 192041 = Hospital System Supply Identifier | 210147 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 66MM","code_information":[{"code":"Sx00-7053-066","type":"CDM"},{"code":"272","type":"RC"},{"code":"193493","type":"LOCAL"},{"code":"310992","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 193493 = Hospital System Supply Identifier | 310992 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 66MM","code_information":[{"code":"Sx00-7053-066","type":"CDM"},{"code":"272","type":"RC"},{"code":"193497","type":"LOCAL"},{"code":"310999","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 193497 = Hospital System Supply Identifier | 310999 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"193494","type":"LOCAL"},{"code":"310993","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 193494 = Hospital System Supply Identifier | 310993 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"193498","type":"LOCAL"},{"code":"311000","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 193498 = Hospital System Supply Identifier | 311000 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"195056","type":"LOCAL"},{"code":"361331","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 195056 = Hospital System Supply Identifier | 361331 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"195058","type":"LOCAL"},{"code":"361333","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 195058 = Hospital System Supply Identifier | 361333 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"195059","type":"LOCAL"},{"code":"361334","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 195059 = Hospital System Supply Identifier | 361334 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"195057","type":"LOCAL"},{"code":"361332","type":"LOCAL"}],"standard_charges":[{"gross_charge":3780.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 195057 = Hospital System Supply Identifier | 361332 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 28X48MM","code_information":[{"code":"Sx00-7105-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198404","type":"LOCAL"},{"code":"443656","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 198404 = Hospital System Supply Identifier | 443656 = Lawson ID"}]},{"description":"IMP HIP ACET LNR NEUT 0D 28X50","code_information":[{"code":"Sx00-7105-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320927","type":"LOCAL"},{"code":"534141","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320927 = Hospital System Supply Identifier | 534141 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 28X52MM","code_information":[{"code":"Sx00-7105-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198403","type":"LOCAL"},{"code":"443655","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 198403 = Hospital System Supply Identifier | 443655 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X54MM","code_information":[{"code":"Sx00-7105-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202086","type":"LOCAL"},{"code":"452182","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202086 = Hospital System Supply Identifier | 452182 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 54X28","code_information":[{"code":"Sx00-7105-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320928","type":"LOCAL"},{"code":"534142","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320928 = Hospital System Supply Identifier | 534142 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 56X28","code_information":[{"code":"Sx00-7105-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320929","type":"LOCAL"},{"code":"534143","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320929 = Hospital System Supply Identifier | 534143 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 56X32","code_information":[{"code":"Sx00-7105-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320930","type":"LOCAL"},{"code":"534144","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320930 = Hospital System Supply Identifier | 534144 = Lawson ID"}]},{"description":"LINER REV HIP TM NEU LNG 36X58","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"195289","type":"LOCAL"},{"code":"372221","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 195289 = Hospital System Supply Identifier | 372221 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 58X28","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320931","type":"LOCAL"},{"code":"534145","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320931 = Hospital System Supply Identifier | 534145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 58X32","code_information":[{"code":"Sx00-7105-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320932","type":"LOCAL"},{"code":"534146","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320932 = Hospital System Supply Identifier | 534146 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X36","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320934","type":"LOCAL"},{"code":"534148","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320934 = Hospital System Supply Identifier | 534148 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 32X60MM","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198402","type":"LOCAL"},{"code":"443654","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 198402 = Hospital System Supply Identifier | 443654 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X28","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320933","type":"LOCAL"},{"code":"534147","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320933 = Hospital System Supply Identifier | 534147 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X36","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320937","type":"LOCAL"},{"code":"534151","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320937 = Hospital System Supply Identifier | 534151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X32","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320936","type":"LOCAL"},{"code":"534150","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320936 = Hospital System Supply Identifier | 534150 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 40X62MM","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"198400","type":"LOCAL"},{"code":"443652","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 198400 = Hospital System Supply Identifier | 443652 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X28","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320935","type":"LOCAL"},{"code":"534149","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320935 = Hospital System Supply Identifier | 534149 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X36","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320940","type":"LOCAL"},{"code":"534154","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320940 = Hospital System Supply Identifier | 534154 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X32","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320939","type":"LOCAL"},{"code":"534153","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320939 = Hospital System Supply Identifier | 534153 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 0D 40X66-70","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202085","type":"LOCAL"},{"code":"452181","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202085 = Hospital System Supply Identifier | 452181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 66-70X28","code_information":[{"code":"Sx00-7105-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320938","type":"LOCAL"},{"code":"534152","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320938 = Hospital System Supply Identifier | 534152 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X28","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320941","type":"LOCAL"},{"code":"534155","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320941 = Hospital System Supply Identifier | 534155 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X32","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320942","type":"LOCAL"},{"code":"534156","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320942 = Hospital System Supply Identifier | 534156 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X36","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320943","type":"LOCAL"},{"code":"534157","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320943 = Hospital System Supply Identifier | 534157 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 72/74X40","code_information":[{"code":"Sx00-7105-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320944","type":"LOCAL"},{"code":"534158","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320944 = Hospital System Supply Identifier | 534158 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X28","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320945","type":"LOCAL"},{"code":"534159","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320945 = Hospital System Supply Identifier | 534159 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X32","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320946","type":"LOCAL"},{"code":"534160","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320946 = Hospital System Supply Identifier | 534160 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X36","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320947","type":"LOCAL"},{"code":"534161","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320947 = Hospital System Supply Identifier | 534161 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X40","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320948","type":"LOCAL"},{"code":"534162","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320948 = Hospital System Supply Identifier | 534162 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 48X28","code_information":[{"code":"Sx00-7110-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320949","type":"LOCAL"},{"code":"534163","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320949 = Hospital System Supply Identifier | 534163 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 50X28","code_information":[{"code":"Sx00-7110-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320950","type":"LOCAL"},{"code":"534164","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320950 = Hospital System Supply Identifier | 534164 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 52X28","code_information":[{"code":"Sx00-7110-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320951","type":"LOCAL"},{"code":"534165","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320951 = Hospital System Supply Identifier | 534165 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 54X28","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320952","type":"LOCAL"},{"code":"534166","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320952 = Hospital System Supply Identifier | 534166 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 32X54MM","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202098","type":"LOCAL"},{"code":"452194","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202098 = Hospital System Supply Identifier | 452194 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X32","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320954","type":"LOCAL"},{"code":"534168","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320954 = Hospital System Supply Identifier | 534168 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X28","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320953","type":"LOCAL"},{"code":"534167","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320953 = Hospital System Supply Identifier | 534167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY 58X36","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202100","type":"LOCAL"},{"code":"452196","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202100 = Hospital System Supply Identifier | 452196 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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60X36MM","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202101","type":"LOCAL"},{"code":"452197","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202101 = Hospital System Supply Identifier | 452197 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X28","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320957","type":"LOCAL"},{"code":"534171","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320957 = Hospital System Supply Identifier | 534171 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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40X62/64","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202099","type":"LOCAL"},{"code":"452195","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 202099 = Hospital System Supply Identifier | 452195 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62/64X28","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320959","type":"LOCAL"},{"code":"534173","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320959 = Hospital System Supply Identifier | 534173 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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72/74X40","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320967","type":"LOCAL"},{"code":"534181","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320967 = Hospital System Supply Identifier | 534181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X28","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320964","type":"LOCAL"},{"code":"534178","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320964 = Hospital System Supply Identifier | 534178 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X32","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320965","type":"LOCAL"},{"code":"534179","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320965 = Hospital System Supply Identifier | 534179 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X40","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320971","type":"LOCAL"},{"code":"534185","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320971 = Hospital System Supply Identifier | 534185 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 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66/68/70X36","code_information":[{"code":"Sx00-7115-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320975","type":"LOCAL"},{"code":"534189","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320975 = Hospital System Supply Identifier | 534189 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 72/74X36","code_information":[{"code":"Sx00-7115-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320976","type":"LOCAL"},{"code":"534190","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320976 = Hospital System Supply Identifier | 534190 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 76/78/80X36","code_information":[{"code":"Sx00-7115-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320977","type":"LOCAL"},{"code":"534191","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 320977 = Hospital System Supply Identifier | 534191 = Lawson ID"}]},{"description":"IMP ACET CAGE SHRT FLG RT","code_information":[{"code":"Sx00-7123-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"327052","type":"LOCAL"},{"code":"409658","type":"LOCAL"}],"standard_charges":[{"gross_charge":9835.0,"discounted_cash":4130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 327052 = Hospital System Supply Identifier | 409658 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT RT 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56/58/60","code_information":[{"code":"Sx00-7124-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321697","type":"LOCAL"},{"code":"534911","type":"LOCAL"}],"standard_charges":[{"gross_charge":9835.0,"discounted_cash":4130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 321697 = Hospital System Supply Identifier | 534911 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 62/64","code_information":[{"code":"Sx00-7124-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321698","type":"LOCAL"},{"code":"534912","type":"LOCAL"}],"standard_charges":[{"gross_charge":9835.0,"discounted_cash":4130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 321698 = Hospital System Supply Identifier | 534912 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 66/68/70","code_information":[{"code":"Sx00-7124-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321699","type":"LOCAL"},{"code":"534913","type":"LOCAL"}],"standard_charges":[{"gross_charge":9835.0,"discounted_cash":4130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 321699 = Hospital System Supply Identifier | 534913 = Lawson ID"}]},{"description":"IMP HIP CAGE SHRT LT 72/74","code_information":[{"code":"Sx00-7124-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321700","type":"LOCAL"},{"code":"534914","type":"LOCAL"}],"standard_charges":[{"gross_charge":9835.0,"discounted_cash":4130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 321700 = Hospital System Supply Identifier | 534914 = Lawson ID"}]},{"description":"IMP HIP SHELL TM SHRT CAGE LT","code_information":[{"code":"Sx00-7124-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326914","type":"LOCAL"},{"code":"402766","type":"LOCAL"}],"standard_charges":[{"gross_charge":9835.0,"discounted_cash":4130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 326914 = Hospital System Supply Identifier | 402766 = Lawson ID"}]},{"description":"IMP HIP CAGE LNG RT 56/58/60","code_information":[{"code":"Sx00-7125-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"321701","type":"LOCAL"},{"code":"534915","type":"LOCAL"}],"standard_charges":[{"gross_charge":9835.0,"discounted_cash":4130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 321701 = Hospital System Supply Identifier | 534915 = Lawson ID"}]},{"description":"IMP HIP CAGE LNG RT 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HUM","code_information":[{"code":"Sx00-8400-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"744116","type":"LOCAL"},{"code":"456596","type":"LOCAL"}],"standard_charges":[{"gross_charge":1313.08,"discounted_cash":551.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 744116 = Hospital System Supply Identifier | 456596 = Lawson ID"}]},{"description":"KIT ARTICULATION SZ 4","code_information":[{"code":"Sx00-8400-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"744117","type":"LOCAL"},{"code":"456597","type":"LOCAL"}],"standard_charges":[{"gross_charge":4645.26,"discounted_cash":1951.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 744117 = Hospital System Supply Identifier | 456597 = Lawson ID"}]},{"description":"KIT ARTICULATION SZ 5","code_information":[{"code":"Sx00-8400-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"744118","type":"LOCAL"},{"code":"456598","type":"LOCAL"}],"standard_charges":[{"gross_charge":4645.26,"discounted_cash":1951.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 744118 = Hospital System Supply Identifier | 456598 = Lawson ID"}]},{"description":"IMP ELBOW RADIAL HEAD 22MM","code_information":[{"code":"Sx00-8700-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"722287","type":"LOCAL"},{"code":"733734","type":"LOCAL"}],"standard_charges":[{"gross_charge":11219.64,"discounted_cash":4712.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 722287 = Hospital System Supply Identifier | 733734 = Lawson ID"}]},{"description":"IMP ELBOW RADIAL HEAD 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B","code_information":[{"code":"Sx00000004259","type":"CDM"},{"code":"272","type":"RC"},{"code":"795638","type":"LOCAL"},{"code":"775107","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795638 = Hospital System Supply Identifier | 775107 = Lawson ID"}]},{"description":"DISC - SET BOWL CELL SAVER RESVR 40MM","code_information":[{"code":"Sx00000004260","type":"CDM"},{"code":"272","type":"RC"},{"code":"400318","type":"LOCAL"},{"code":"636998","type":"LOCAL"}],"standard_charges":[{"gross_charge":646.64,"discounted_cash":271.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 400318 = Hospital System Supply Identifier | 636998 = Lawson ID"}]},{"description":"SET PROC BX/55","code_information":[{"code":"Sx00000004261","type":"CDM"},{"code":"272","type":"RC"},{"code":"795639","type":"LOCAL"},{"code":"775108","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795639 = Hospital System Supply Identifier | 775108 = Lawson ID"}]},{"description":"SET PROC BX/125","code_information":[{"code":"Sx00000004262","type":"CDM"},{"code":"272","type":"RC"},{"code":"795640","type":"LOCAL"},{"code":"775109","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795640 = Hospital System Supply Identifier | 775109 = Lawson ID"}]},{"description":"SET PROC BX/175","code_information":[{"code":"Sx00000004263","type":"CDM"},{"code":"272","type":"RC"},{"code":"795641","type":"LOCAL"},{"code":"775110","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795641 = Hospital System Supply Identifier | 775110 = Lawson ID"}]},{"description":"SET PROC BX/225","code_information":[{"code":"Sx00000004264","type":"CDM"},{"code":"272","type":"RC"},{"code":"795642","type":"LOCAL"},{"code":"775111","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.92,"discounted_cash":769.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795642 = Hospital System Supply Identifier | 775111 = Lawson ID"}]},{"description":"SET COLL BX","code_information":[{"code":"Sx00000004265","type":"CDM"},{"code":"272","type":"RC"},{"code":"795643","type":"LOCAL"},{"code":"775112","type":"LOCAL"}],"standard_charges":[{"gross_charge":833.17,"discounted_cash":349.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795643 = Hospital System Supply Identifier | 775112 = Lawson ID"}]},{"description":"SET COLL TX CARDIO","code_information":[{"code":"Sx00000004266","type":"CDM"},{"code":"272","type":"RC"},{"code":"795644","type":"LOCAL"},{"code":"775113","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.4,"discounted_cash":355.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795644 = Hospital System Supply Identifier | 775113 = Lawson ID"}]},{"description":"SET COLL BX CARDIO","code_information":[{"code":"Sx00000004267","type":"CDM"},{"code":"272","type":"RC"},{"code":"795645","type":"LOCAL"},{"code":"775114","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.4,"discounted_cash":355.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795645 = Hospital System Supply Identifier | 775114 = Lawson ID"}]},{"description":"HOLDER RESERVOIR PERFUSION CARDIOTOMY BLOOD COLLECTION XRES 04272","code_information":[{"code":"Sx00000004272","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531023","type":"LOCAL"},{"code":"1104783","type":"LOCAL"}],"standard_charges":[{"gross_charge":6418.94,"discounted_cash":2695.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531023 = Hospital System Supply Identifier | 1104783 = Lawson ID"}]},{"description":"RESERVOIR BLD COLL XRES B 120","code_information":[{"code":"Sx00000004275","type":"CDM"},{"code":"272","type":"RC"},{"code":"795647","type":"LOCAL"},{"code":"775116","type":"LOCAL"}],"standard_charges":[{"gross_charge":575.86,"discounted_cash":241.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795647 = Hospital System Supply Identifier | 775116 = Lawson ID"}]},{"description":"SET COLL BX CARDIO 120UM","code_information":[{"code":"Sx00000004277","type":"CDM"},{"code":"272","type":"RC"},{"code":"795648","type":"LOCAL"},{"code":"775117","type":"LOCAL"}],"standard_charges":[{"gross_charge":972.09,"discounted_cash":408.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795648 = Hospital System Supply Identifier | 775117 = Lawson ID"}]},{"description":"SET PROC BX/225 120UM","code_information":[{"code":"Sx00000004278","type":"CDM"},{"code":"272","type":"RC"},{"code":"795649","type":"LOCAL"},{"code":"775118","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 795649 = Hospital System Supply Identifier | 775118 = Lawson ID"}]},{"description":"DISC - CATH IMPELLA RP","code_information":[{"code":"Sx00000004334","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"473003","type":"LOCAL"},{"code":"595771","type":"LOCAL"}],"standard_charges":[{"gross_charge":107000.0,"discounted_cash":44940.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 473003 = Hospital System Supply Identifier | 595771 = Lawson ID"}]},{"description":"LEAD SNSE AIRWAY UPPER INSPIRE","code_information":[{"code":"Sx00000004340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"709294","type":"LOCAL"},{"code":"726033","type":"LOCAL"}],"standard_charges":[{"gross_charge":16470.0,"discounted_cash":6917.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 709294 = Hospital System Supply Identifier | 726033 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION MINIMAL BLEEDING SM XTRA 04350 55ML","code_information":[{"code":"Sx00000004350","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531013","type":"LOCAL"},{"code":"1104690","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.2,"discounted_cash":474.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531013 = Hospital System Supply Identifier | 1104690 = Lawson ID"}]},{"description":"BARRIER ADH INTERCEED 3X4IN","code_information":[{"code":"Sx00000004350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"},{"code":"20936","type":"LOCAL"},{"code":"104075","type":"LOCAL"}],"standard_charges":[{"gross_charge":3667.29,"discounted_cash":1540.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 20936 = Hospital System Supply Identifier | 104075 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION LOW BLEEDING STD CELL XTRA 04351 125ML","code_information":[{"code":"Sx00000004351","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531008","type":"LOCAL"},{"code":"1104668","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.2,"discounted_cash":474.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531008 = Hospital System Supply Identifier | 1104668 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION MEDIUM BLEEDING INTMED XTRA 04352 175ML","code_information":[{"code":"Sx00000004352","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531018","type":"LOCAL"},{"code":"1104747","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.2,"discounted_cash":474.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531018 = Hospital System Supply Identifier | 1104747 = Lawson ID"}]},{"description":"BOWL SET CORONARY PERFUSION HIGH BLEEDING LARGEST XTRA 04353 225ML","code_information":[{"code":"Sx00000004353","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531012","type":"LOCAL"},{"code":"1104687","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.2,"discounted_cash":474.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531012 = Hospital System Supply Identifier | 1104687 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04354 55ML","code_information":[{"code":"Sx00000004354","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531019","type":"LOCAL"},{"code":"1104748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531019 = Hospital System Supply Identifier | 1104748 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04355 125ML","code_information":[{"code":"Sx00000004355","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531024","type":"LOCAL"},{"code":"1104808","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531024 = Hospital System Supply Identifier | 1104808 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04356 175ML","code_information":[{"code":"Sx00000004356","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531015","type":"LOCAL"},{"code":"1104721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531015 = Hospital System Supply Identifier | 1104721 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION TX CARD BOWL XTRA 04357 225ML","code_information":[{"code":"Sx00000004357","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531022","type":"LOCAL"},{"code":"1104780","type":"LOCAL"}],"standard_charges":[{"gross_charge":1797.64,"discounted_cash":755.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531022 = Hospital System Supply Identifier | 1104780 = Lawson ID"}]},{"description":"RESERVOIR PERFUSION CARDIOTOMY TOP OUTLET BLOOD XTRA XRES 04358","code_information":[{"code":"Sx00000004358","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531014","type":"LOCAL"},{"code":"1104700","type":"LOCAL"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":231.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531014 = Hospital System Supply Identifier | 1104700 = Lawson ID"}]},{"description":"RESERVOIR PERFUSION CARDIOTOMY BOTTOM OUTLET BLOOD XTRA XRES 04359","code_information":[{"code":"Sx00000004359","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531026","type":"LOCAL"},{"code":"1104818","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531026 = Hospital System Supply Identifier | 1104818 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION TX XTRA 04360","code_information":[{"code":"Sx00000004360","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531020","type":"LOCAL"},{"code":"1104756","type":"LOCAL"}],"standard_charges":[{"gross_charge":833.17,"discounted_cash":349.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531020 = Hospital System Supply Identifier | 1104756 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04361 55ML","code_information":[{"code":"Sx00000004361","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531011","type":"LOCAL"},{"code":"1104681","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531011 = Hospital System Supply Identifier | 1104681 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04362 125ML","code_information":[{"code":"Sx00000004362","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531000","type":"LOCAL"},{"code":"1104630","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531000 = Hospital System Supply Identifier | 1104630 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04363 175ML","code_information":[{"code":"Sx00000004363","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531007","type":"LOCAL"},{"code":"1104667","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531007 = Hospital System Supply Identifier | 1104667 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX BOWL XTRA 04364 225ML","code_information":[{"code":"Sx00000004364","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531029","type":"LOCAL"},{"code":"1104832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1831.92,"discounted_cash":769.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531029 = Hospital System Supply Identifier | 1104832 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION BX XTRA 04365","code_information":[{"code":"Sx00000004365","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531021","type":"LOCAL"},{"code":"1104779","type":"LOCAL"}],"standard_charges":[{"gross_charge":833.17,"discounted_cash":349.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531021 = Hospital System Supply Identifier | 1104779 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION TX CARDIO XTRA 04366","code_information":[{"code":"Sx00000004366","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531003","type":"LOCAL"},{"code":"1104794","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.4,"discounted_cash":355.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531003 = Hospital System Supply Identifier | 1104794 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION BX CARDIO XTRA 04367","code_information":[{"code":"Sx00000004367","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531017","type":"LOCAL"},{"code":"1104745","type":"LOCAL"}],"standard_charges":[{"gross_charge":846.4,"discounted_cash":355.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531017 = Hospital System Supply Identifier | 1104745 = Lawson ID"}]},{"description":"BAG CORONARY PERFUSION WASTE WB10 XTRA 04369 10L","code_information":[{"code":"Sx00000004369","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531028","type":"LOCAL"},{"code":"1104827","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531028 = Hospital System Supply Identifier | 1104827 = Lawson ID"}]},{"description":"RESERVOIR SET CORONARY PERFUSION B BLOOD XTRA XRES 04375 120UM","code_information":[{"code":"Sx00000004375","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531006","type":"LOCAL"},{"code":"1104645","type":"LOCAL"}],"standard_charges":[{"gross_charge":575.86,"discounted_cash":241.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531006 = Hospital System Supply Identifier | 1104645 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION B GROSS FILTER XTRA 04376 120UM","code_information":[{"code":"Sx00000004376","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531005","type":"LOCAL"},{"code":"1104625","type":"LOCAL"}],"standard_charges":[{"gross_charge":1296.05,"discounted_cash":544.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531005 = Hospital System Supply Identifier | 1104625 = Lawson ID"}]},{"description":"COLLECTION SET CORONARY PERFUSION B CARDIO GROSS XTRA 04377 120UM","code_information":[{"code":"Sx00000004377","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531002","type":"LOCAL"},{"code":"1104743","type":"LOCAL"}],"standard_charges":[{"gross_charge":972.09,"discounted_cash":408.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531002 = Hospital System Supply Identifier | 1104743 = Lawson ID"}]},{"description":"PROCEDURE SET CORONARY PERFUSION BX 225 GROSS XTRA 04378 225MLX120UM","code_information":[{"code":"Sx00000004378","type":"CDM"},{"code":"272","type":"RC"},{"code":"1531016","type":"LOCAL"},{"code":"1104733","type":"LOCAL"}],"standard_charges":[{"gross_charge":1944.07,"discounted_cash":816.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 1531016 = Hospital System Supply Identifier | 1104733 = Lawson ID"}]},{"description":"GUIDE STABILIZING TEND F/RCR","code_information":[{"code":"Sx00000004402","type":"CDM"},{"code":"272","type":"RC"},{"code":"624878","type":"LOCAL"},{"code":"688373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1447.34,"discounted_cash":607.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 624878 = Hospital System Supply Identifier | 688373 = Lawson ID"}]},{"description":"LD/ADPT IS1 BP TO LV1 BP 17CM","code_information":[{"code":"Sx00000004402","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"602925","type":"LOCAL"},{"code":"682750","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 602925 = Hospital System Supply Identifier | 682750 = Lawson ID"}]},{"description":"LD/ADP LV-1 BP TO IS-1 BP 17CM","code_information":[{"code":"Sx00000004403","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1883","type":"HCPCS"},{"code":"602221","type":"LOCAL"},{"code":"320541","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 602221 = Hospital System Supply Identifier | 320541 = Lawson ID"}]},{"description":"ANCHORS BONE WITH ARTHOSCOPIC","code_information":[{"code":"Sx00000004403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"804598","type":"LOCAL"}],"standard_charges":[{"gross_charge":5960.5,"discounted_cash":2503.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 804598 = Hospital System Supply Identifier"}]},{"description":"ANCHR BONE 3 W/ ADV DELY SYS","code_information":[{"code":"Sx00000004403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"960277","type":"LOCAL"},{"code":"838520","type":"LOCAL"}],"standard_charges":[{"gross_charge":5960.5,"discounted_cash":2503.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 960277 = Hospital System Supply Identifier | 838520 = Lawson ID"}]},{"description":"OFF CONTRACT - RAIL END ADPT XS","code_information":[{"code":"Sx00000004410","type":"CDM"},{"code":"272","type":"RC"},{"code":"746911","type":"LOCAL"},{"code":"757452","type":"LOCAL"}],"standard_charges":[{"gross_charge":2391.54,"discounted_cash":1004.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 746911 = Hospital System Supply Identifier | 757452 = Lawson ID"}]},{"description":"DISC - RAIL 10CM XS","code_information":[{"code":"Sx00000004411","type":"CDM"},{"code":"272","type":"RC"},{"code":"746917","type":"LOCAL"},{"code":"757458","type":"LOCAL"}],"standard_charges":[{"gross_charge":4543.08,"discounted_cash":1908.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 746917 = Hospital System Supply Identifier | 757458 = Lawson ID"}]},{"description":"DISC - RAIL 15CM XS","code_information":[{"code":"Sx00000004416","type":"CDM"},{"code":"272","type":"RC"},{"code":"746918","type":"LOCAL"},{"code":"757459","type":"LOCAL"}],"standard_charges":[{"gross_charge":5403.45,"discounted_cash":2269.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 746918 = Hospital System Supply Identifier | 757459 = Lawson ID"}]},{"description":"DISC - RAIL 20CM XS","code_information":[{"code":"Sx00000004421","type":"CDM"},{"code":"272","type":"RC"},{"code":"746919","type":"LOCAL"},{"code":"757460","type":"LOCAL"}],"standard_charges":[{"gross_charge":6265.35,"discounted_cash":2631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: TLM LOCATION | 746919 = Hospital System Supply Identifier | 757460 = Lawson ID"}]},{"description":"DISC - RAIL 25CM 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