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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":"Baylor Scott and White","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PAR","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"CapStar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Employers Health Network","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"All 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36X22","code_information":[{"code":"Sx00-6310-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304258","type":"LOCAL"},{"code":"523215","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304258 = Hospital System Supply Identifier | 523215 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 38X22","code_information":[{"code":"Sx00-6310-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304259","type":"LOCAL"},{"code":"523216","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304259 = Hospital System Supply Identifier | 523216 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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: NMHB 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: NMHB LOCATION | 328932 = Hospital System Supply Identifier | 204640 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 42X26","code_information":[{"code":"Sx00-6310-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304261","type":"LOCAL"},{"code":"523218","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304261 = Hospital System Supply Identifier | 523218 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-44-22","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328931","type":"LOCAL"},{"code":"204639","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 328931 = Hospital System Supply Identifier | 204639 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X44MM","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326725","type":"LOCAL"},{"code":"408165","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 326725 = Hospital System Supply Identifier | 408165 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 28X44MM","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196298","type":"LOCAL"},{"code":"408166","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 196298 = Hospital System Supply Identifier | 408166 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 28X46MM","code_information":[{"code":"Sx00-6310-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196299","type":"LOCAL"},{"code":"408168","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 196299 = Hospital System Supply Identifier | 408168 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 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: NMHB 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: NMHB LOCATION | 326726 = Hospital System Supply Identifier | 408167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X48MM","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326727","type":"LOCAL"},{"code":"408169","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 326727 = Hospital System Supply Identifier | 408169 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 32X48MM","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196300","type":"LOCAL"},{"code":"408170","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 196300 = Hospital System Supply Identifier | 408170 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-48-28","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167751","type":"LOCAL"},{"code":"203488","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 167751 = Hospital System Supply Identifier | 203488 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 48X22","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304262","type":"LOCAL"},{"code":"523219","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304262 = Hospital System Supply Identifier | 523219 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 50-54X22","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304263","type":"LOCAL"},{"code":"523220","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304263 = Hospital System Supply Identifier | 523220 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168180","type":"LOCAL"},{"code":"206426","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 168180 = Hospital System Supply Identifier | 206426 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-50-28","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167756","type":"LOCAL"},{"code":"203496","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 167756 = Hospital System Supply Identifier | 203496 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X50MM","code_information":[{"code":"Sx00-6310-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326728","type":"LOCAL"},{"code":"408171","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 326728 = Hospital System Supply Identifier | 408171 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-56-28","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167755","type":"LOCAL"},{"code":"203495","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 167755 = Hospital System Supply Identifier | 203495 = Lawson ID"}]},{"description":"LINER ACETAB 32M 10 LONGEVITY","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"328960","type":"LOCAL"},{"code":"206427","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 328960 = Hospital System Supply Identifier | 206427 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X56MM","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326729","type":"LOCAL"},{"code":"408172","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 326729 = Hospital System Supply Identifier | 408172 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X22","code_information":[{"code":"Sx00-6310-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304264","type":"LOCAL"},{"code":"523221","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304264 = Hospital System Supply Identifier | 523221 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X22","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304265","type":"LOCAL"},{"code":"523222","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304265 = Hospital System Supply Identifier | 523222 = Lawson ID"}]},{"description":"IMP HIP ACET LNR LGVTY 36MM","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"149141","type":"LOCAL"},{"code":"236444","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 149141 = Hospital System Supply Identifier | 236444 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X58MM","code_information":[{"code":"Sx00-6310-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326730","type":"LOCAL"},{"code":"408173","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 326730 = Hospital System Supply Identifier | 408173 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 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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: NMHB 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: NMHB 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: NMHB 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: NMHB LOCATION | 304307 = Hospital System Supply Identifier | 523264 = 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: NMHB LOCATION | 304310 = Hospital System Supply Identifier | 523267 = 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: NMHB LOCATION | 304309 = Hospital System Supply Identifier | 523266 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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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: NMHB LOCATION | 304314 = Hospital System Supply Identifier | 523271 = 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: NMHB LOCATION | 304315 = Hospital System Supply Identifier | 523272 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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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: NMHB LOCATION | 304319 = Hospital System Supply Identifier | 523276 = 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: NMHB LOCATION | 304318 = Hospital System Supply Identifier | 523275 = 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: NMHB LOCATION | 324848 = Hospital System Supply Identifier | 324312 = 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: NMHB LOCATION | 150025 = Hospital System Supply Identifier | 237682 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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56X26","code_information":[{"code":"Sx00-6320-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304321","type":"LOCAL"},{"code":"523278","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304321 = Hospital System Supply Identifier | 523278 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 56X28","code_information":[{"code":"Sx00-6320-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304322","type":"LOCAL"},{"code":"523279","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304322 = Hospital System Supply Identifier | 523279 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 58X32","code_information":[{"code":"Sx00-6320-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304326","type":"LOCAL"},{"code":"523283","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304326 = Hospital System Supply Identifier | 523283 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 58X28","code_information":[{"code":"Sx00-6320-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304325","type":"LOCAL"},{"code":"523282","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304325 = Hospital System Supply Identifier | 523282 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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60X22","code_information":[{"code":"Sx00-6320-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304327","type":"LOCAL"},{"code":"523284","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304327 = Hospital System Supply Identifier | 523284 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 60X26","code_information":[{"code":"Sx00-6320-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304328","type":"LOCAL"},{"code":"523285","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304328 = Hospital System Supply Identifier | 523285 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 60X28","code_information":[{"code":"Sx00-6320-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304329","type":"LOCAL"},{"code":"523286","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304329 = Hospital System Supply Identifier | 523286 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 60X32","code_information":[{"code":"Sx00-6320-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304330","type":"LOCAL"},{"code":"523287","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304330 = Hospital System Supply Identifier | 523287 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 62X22","code_information":[{"code":"Sx00-6320-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304331","type":"LOCAL"},{"code":"523288","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304331 = Hospital System Supply Identifier | 523288 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 62X26","code_information":[{"code":"Sx00-6320-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304332","type":"LOCAL"},{"code":"523289","type":"LOCAL"}],"standard_charges":[{"gross_charge":6424.88,"discounted_cash":2698.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304332 = Hospital System Supply Identifier | 523289 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 62X28","code_information":[{"code":"Sx00-6320-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304333","type":"LOCAL"},{"code":"523290","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304333 = Hospital System Supply Identifier | 523290 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 62X32","code_information":[{"code":"Sx00-6320-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304334","type":"LOCAL"},{"code":"523291","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304334 = Hospital System Supply Identifier | 523291 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 64X28","code_information":[{"code":"Sx00-6320-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304337","type":"LOCAL"},{"code":"523294","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 304337 = Hospital System Supply Identifier | 523294 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 64X32","code_information":[{"code":"Sx00-6320-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"325148","type":"LOCAL"},{"code":"340105","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 325148 = Hospital System Supply Identifier | 340105 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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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: NMHB LOCATION | 320933 = Hospital System Supply Identifier | 534147 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 60X36","code_information":[{"code":"Sx00-7105-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"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: NMHB LOCATION | 320934 = Hospital System Supply Identifier | 534148 = 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: NMHB LOCATION | 320937 = Hospital System Supply Identifier | 534151 = 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: NMHB LOCATION | 320935 = Hospital System Supply Identifier | 534149 = 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: NMHB LOCATION | 198400 = Hospital System Supply Identifier | 443652 = 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: NMHB LOCATION | 320936 = Hospital System Supply Identifier | 534150 = 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: NMHB 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: NMHB LOCATION | 320938 = Hospital System Supply Identifier | 534152 = 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: NMHB LOCATION | 320939 = Hospital System Supply Identifier | 534153 = 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: NMHB LOCATION | 320940 = Hospital System Supply Identifier | 534154 = 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: NMHB 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: NMHB LOCATION | 320944 = Hospital System Supply Identifier | 534158 = 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: NMHB 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: NMHB LOCATION | 320942 = Hospital System Supply Identifier | 534156 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X28","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"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: NMHB 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: NMHB 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: NMHB 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: NMHB 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: NMHB 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: NMHB 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: NMHB 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: NMHB 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: NMHB LOCATION | 202098 = Hospital System Supply Identifier | 452194 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X28","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"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: NMHB LOCATION | 320953 = Hospital System Supply Identifier | 534167 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 56X32","code_information":[{"code":"Sx00-7110-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"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: NMHB LOCATION | 320954 = Hospital System Supply Identifier | 534168 = 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: NMHB LOCATION | 202100 = Hospital System Supply Identifier | 452196 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X28","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320955","type":"LOCAL"},{"code":"534169","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320955 = Hospital System Supply Identifier | 534169 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 58X32","code_information":[{"code":"Sx00-7110-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320956","type":"LOCAL"},{"code":"534170","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320956 = Hospital System Supply Identifier | 534170 = Lawson ID"}]},{"description":"IMP HIP ACET LNR10D 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: NMHB 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: NMHB LOCATION | 320957 = Hospital System Supply Identifier | 534171 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 60X32","code_information":[{"code":"Sx00-7110-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320958","type":"LOCAL"},{"code":"534172","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320958 = Hospital System Supply Identifier | 534172 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40X62/64","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"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: NMHB 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: NMHB LOCATION | 320959 = Hospital System Supply Identifier | 534173 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320960","type":"LOCAL"},{"code":"534174","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320960 = Hospital System Supply Identifier | 534174 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 62X32","code_information":[{"code":"Sx00-7110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320961","type":"LOCAL"},{"code":"534175","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320961 = Hospital System Supply Identifier | 534175 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 36X62/64","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202102","type":"LOCAL"},{"code":"452198","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 202102 = Hospital System Supply Identifier | 452198 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X28","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320962","type":"LOCAL"},{"code":"534176","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320962 = Hospital System Supply Identifier | 534176 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 40MM","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"194975","type":"LOCAL"},{"code":"360636","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 194975 = Hospital System Supply Identifier | 360636 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X32","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320963","type":"LOCAL"},{"code":"534177","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320963 = Hospital System Supply Identifier | 534177 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X40","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"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: NMHB LOCATION | 320967 = Hospital System Supply Identifier | 534181 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 72/74X36","code_information":[{"code":"Sx00-7110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320966","type":"LOCAL"},{"code":"534180","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320966 = Hospital System Supply Identifier | 534180 = 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: NMHB 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: NMHB LOCATION | 320965 = Hospital System Supply Identifier | 534179 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X28","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320968","type":"LOCAL"},{"code":"534182","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320968 = Hospital System Supply Identifier | 534182 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X32","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320969","type":"LOCAL"},{"code":"534183","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320969 = Hospital System Supply Identifier | 534183 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X36","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"320970","type":"LOCAL"},{"code":"534184","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 320970 = Hospital System Supply Identifier | 534184 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 76-80X40","code_information":[{"code":"Sx00-7110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"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: NMHB LOCATION | 320971 = Hospital System Supply Identifier | 534185 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 28X50MM","code_information":[{"code":"Sx00-7115-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"196301","type":"LOCAL"},{"code":"408185","type":"LOCAL"}],"standard_charges":[{"gross_charge":9264.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 196301 = Hospital System Supply Identifier | 408185 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 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RT","code_information":[{"code":"Sx00-7133-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"449682","type":"LOCAL"},{"code":"659248","type":"LOCAL"}],"standard_charges":[{"gross_charge":2947.56,"discounted_cash":1237.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 449682 = Hospital System Supply Identifier | 659248 = Lawson ID"}]},{"description":"IMP HIP CAGE FLNG 66-70 58MM","code_information":[{"code":"Sx00-7133-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"202047","type":"LOCAL"},{"code":"452139","type":"LOCAL"}],"standard_charges":[{"gross_charge":2947.56,"discounted_cash":1237.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 202047 = Hospital System Supply Identifier | 452139 = Lawson ID"}]},{"description":"IMP HIP ACET TRBC RT 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DISPOSABLE","code_information":[{"code":"Sx00-7134-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"811996","type":"LOCAL"}],"standard_charges":[{"gross_charge":2947.56,"discounted_cash":1237.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 811996 = Hospital System Supply Identifier"}]},{"description":"IMP LNR TM SHT CAGE LT 76-80","code_information":[{"code":"Sx00-7134-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"449622","type":"LOCAL"},{"code":"360641","type":"LOCAL"}],"standard_charges":[{"gross_charge":2947.56,"discounted_cash":1237.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 449622 = Hospital System Supply Identifier | 360641 = Lawson ID"}]},{"description":"IMP HIP REV CAGE FLNG RT 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109MM","code_information":[{"code":"Sx00-7711-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"485135","type":"LOCAL"},{"code":"441033","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 485135 = Hospital System Supply Identifier | 441033 = Lawson ID"}]},{"description":"IMP HIP FEM STEM REDU M/L 5MM","code_information":[{"code":"Sx00-7711-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305009","type":"LOCAL"},{"code":"523955","type":"LOCAL"}],"standard_charges":[{"gross_charge":8974.5,"discounted_cash":3769.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 305009 = Hospital System Supply Identifier | 523955 = Lawson ID"}]},{"description":"IMP KNEE FEM STEM 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7859-09","code_information":[{"code":"Sx00-7859-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167924","type":"LOCAL"},{"code":"204335","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 167924 = Hospital System Supply Identifier | 204335 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-10","code_information":[{"code":"Sx00-7859-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145635","type":"LOCAL"},{"code":"203792","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 145635 = Hospital System Supply Identifier | 203792 = Lawson ID"}]},{"description":"IMP HIP CNTRLZR DST VS 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7859-13","code_information":[{"code":"Sx00-7859-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145638","type":"LOCAL"},{"code":"203795","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 145638 = Hospital System Supply Identifier | 203795 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-14","code_information":[{"code":"Sx00-7859-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145639","type":"LOCAL"},{"code":"203796","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 145639 = Hospital System Supply Identifier | 203796 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-15","code_information":[{"code":"Sx00-7859-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"167809","type":"LOCAL"},{"code":"203797","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 167809 = Hospital System Supply Identifier | 203797 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-16","code_information":[{"code":"Sx00-7859-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145640","type":"LOCAL"},{"code":"203798","type":"LOCAL"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 145640 = Hospital System Supply Identifier | 203798 = Lawson ID"}]},{"description":"IMP DISTAL CENT 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8018-36-04","code_information":[{"code":"Sx00-8018-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192014","type":"LOCAL"},{"code":"207594","type":"LOCAL"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":1205.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 192014 = Hospital System Supply Identifier | 207594 = Lawson ID"}]},{"description":"HEAD 36MM 8018-36-02","code_information":[{"code":"Sx00-8018-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"168363","type":"LOCAL"},{"code":"207592","type":"LOCAL"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":1205.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 168363 = Hospital System Supply Identifier | 207592 = Lawson ID"}]},{"description":"HEAD 36MM 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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: NMHB 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: NMHB LOCATION | 744117 = Hospital System Supply Identifier | 456597 = Lawson ID"}]},{"description":"KIT ARTICULATION SZ 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MM","code_information":[{"code":"Sx00-8751-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"326221","type":"LOCAL"},{"code":"390521","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 326221 = Hospital System Supply Identifier | 390521 = Lawson ID"}]},{"description":"IMP HIP LNR XLPE 40MM SZMM","code_information":[{"code":"Sx00-8751-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"171793","type":"LOCAL"},{"code":"439196","type":"LOCAL"}],"standard_charges":[{"gross_charge":3712.5,"discounted_cash":1559.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 171793 = Hospital System Supply Identifier | 439196 = Lawson ID"}]},{"description":"IMP HIP LNR EE 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NO.4033","code_information":[{"code":"Sx00000004033","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"168178","type":"LOCAL"},{"code":"206388","type":"LOCAL"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 168178 = Hospital System Supply Identifier | 206388 = Lawson ID"}]},{"description":"LEAD EPICARDIAL R/S 4046","code_information":[{"code":"Sx00000004046","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"149544","type":"LOCAL"},{"code":"236954","type":"LOCAL"}],"standard_charges":[{"gross_charge":2063.1,"discounted_cash":866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 149544 = Hospital System Supply Identifier | 236954 = Lawson ID"}]},{"description":"LEAD EPICARDIAL PACING","code_information":[{"code":"Sx00000004047","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"192169","type":"LOCAL"},{"code":"231389","type":"LOCAL"}],"standard_charges":[{"gross_charge":2063.1,"discounted_cash":866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 192169 = Hospital System Supply Identifier | 231389 = Lawson ID"}]},{"description":"INST BONE COLLECTOR","code_information":[{"code":"Sx00000004049","type":"CDM"},{"code":"272","type":"RC"},{"code":"1053498","type":"LOCAL"},{"code":"878590","type":"LOCAL"}],"standard_charges":[{"gross_charge":942.67,"discounted_cash":395.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 1053498 = Hospital System Supply Identifier | 878590 = Lawson ID"}]},{"description":"LEAD CAPSURE Z SCREW IN","code_information":[{"code":"Sx00000004058","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"193072","type":"LOCAL"},{"code":"243808","type":"LOCAL"}],"standard_charges":[{"gross_charge":2063.1,"discounted_cash":866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 193072 = Hospital System Supply Identifier | 243808 = Lawson ID"}]},{"description":"LEAD STIM AIRWAY UPPER INSPIRE","code_information":[{"code":"Sx00000004063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"709293","type":"LOCAL"},{"code":"726032","type":"LOCAL"}],"standard_charges":[{"gross_charge":10959.0,"discounted_cash":4602.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 709293 = Hospital System Supply Identifier | 726032 = Lawson ID"}]},{"description":"LEAD CPI FLEXTEND 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4137","code_information":[{"code":"Sx00000004137","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1898","type":"HCPCS"},{"code":"146007","type":"LOCAL"},{"code":"301225","type":"LOCAL"}],"standard_charges":[{"gross_charge":2063.1,"discounted_cash":866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 146007 = Hospital System Supply Identifier | 301225 = Lawson ID"}]},{"description":"LEAD RESPIRATORY STIMULATION RESPISTIM LQS 4165 65CM","code_information":[{"code":"Sx00000004165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"},{"code":"1444660","type":"LOCAL"},{"code":"1096211","type":"LOCAL"}],"standard_charges":[{"gross_charge":40860.0,"discounted_cash":17161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 1444660 = Hospital System Supply Identifier | 1096211 = Lawson ID"}]},{"description":"LINE ASPIR/ANTICOAG 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175ML","code_information":[{"code":"Sx00000004252","type":"CDM"},{"code":"272","type":"RC"},{"code":"795637","type":"LOCAL"},{"code":"775106","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.2,"discounted_cash":474.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 795637 = Hospital System Supply Identifier | 775106 = Lawson ID"}]},{"description":"SET BOWL CELL SAVER 225","code_information":[{"code":"Sx00000004253","type":"CDM"},{"code":"272","type":"RC"},{"code":"354024","type":"LOCAL"},{"code":"591212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1129.2,"discounted_cash":474.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: NMHB LOCATION | 354024 = Hospital System Supply Identifier | 591212 = Lawson ID"}]},{"description":"SET CELLSAVER XTRA 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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: NMHB 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: NMHB LOCATION | 795641 = Hospital System Supply Identifier | 775110 = Lawson ID"}]},{"description":"SET PROC 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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: NMHB 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: NMHB LOCATION | 795645 = Hospital System Supply Identifier | 775114 = Lawson ID"}]},{"description":"HOLDER RESERVOIR PERFUSION CARDIOTOMY BLOOD COLLECTION XRES 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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: NMHB 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: NMHB LOCATION | 795649 = Hospital System Supply Identifier | 775118 = Lawson ID"}]},{"description":"DISC - CATH IMPELLA 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